Systolic blood pressure change
Overweight or obesity without diabetes (adults)
In plain language
Across 7 trials with 1,330 participants, 0 of 15 treatments had a clearly better result than placebo on systolic blood pressure change, and for 15 the evidence could not tell them apart from placebo. The most favorable estimate was for Mazdutide 6 mg subcutaneous once weekly: mean difference -9.61 mmHg (95% credible interval -18.70 to 0.87).
Lower values favor the treatment. "Clearly" means the 95% credible interval excludes no difference. These are averages across trials; they do not say how any one person will respond. Not medical advice.
Network of trials
Effects compared with Placebo
| Treatment | Bayesian MD (95% CrI) | 95% prediction interval | Frequentist MD (95% CI) | Verdict |
|---|---|---|---|---|
| Mazdutide 6 mg subcutaneous once weekly MAZD_SC_6MG_QW | -9.61 (-18.70 to 0.87) | -22.92 to 5.44 | -9.80 (-13.13 to -6.47) | Unclear |
| Semaglutide 2.4 mg subcutaneous once weekly SEMA_SC_2p4MG_QW | -6.94 (-18.90 to 5.51) | -22.23 to 9.36 | -7.18 (-15.83 to 1.47) | Unclear |
| Exenatide extended release and dapagliflozin 2 to 10 mg injection once weekly EXENER_SC_2-10MG_QW | -6.64 (-17.50 to 4.71) | -21.31 to 8.43 | -6.80 (-12.53 to -1.07) | Unclear |
| Liraglutide 2.4 mg injection once daily LIRA_SC_2p4MG_QD | -6.45 (-15.65 to 2.63) | -19.90 to 6.96 | -6.35 (-9.98 to -2.72) | Unclear |
| Efpeglenatide 6 mg subcutaneous once weekly EFPE_SC_6MG_QW | -5.86 (-15.20 to 4.13) | -19.43 to 8.11 | -6.00 (-9.75 to -2.25) | Unclear |
| Mazdutide 4.5 mg subcutaneous once weekly MAZD_SC_4p5MG_QW | -4.95 (-14.30 to 5.32) | -18.13 to 9.22 | -5.10 (-8.43 to -1.77) | Unclear |
| Liraglutide 3.0 mg subcutaneous once daily LIRA_SC_3p0MG_QD | -4.45 (-12.56 to 2.75) | -17.03 to 7.57 | -3.92 (-7.09 to -0.76) | Unclear |
| Mazdutide 3 mg subcutaneous once weekly MAZD_SC_3MG_QW | -4.07 (-13.48 to 6.37) | -17.49 to 10.56 | -4.20 (-7.67 to -0.73) | Unclear |
| Liraglutide 1.2 mg subcutaneous once daily LIRA_SC_1p2MG_QD | -3.45 (-12.97 to 5.82) | -17.32 to 10.13 | -3.35 (-6.82 to 0.11) | Unclear |
| Efpeglenatide 4 mg subcutaneous once weekly EFPE_SC_4MG_QW | -3.28 (-12.87 to 7.07) | -16.81 to 10.70 | -3.40 (-7.15 to 0.35) | Unclear |
| Efpeglenatide 8 mg injection every 2 weeks EFPE_SC_8MG_Q2W | -2.70 (-12.28 to 7.21) | -16.57 to 11.94 | -2.90 (-6.65 to 0.85) | Unclear |
| Liraglutide 1.8 mg subcutaneous once daily LIRA_SC_1p8MG_QD | -2.16 (-11.63 to 7.35) | -16.05 to 11.21 | -2.05 (-5.78 to 1.68) | Unclear |
| Orlistat ORLISTAT | -1.72 (-10.95 to 7.75) | -15.12 to 11.50 | -1.55 (-4.97 to 1.87) | Unclear |
| Semaglutide 1.0 mg subcutaneous once weekly SEMA_SC_1p0MG_QW | -1.40 (-11.31 to 8.37) | -14.98 to 12.75 | -1.38 (-4.98 to 2.22) | Unclear |
| Efpeglenatide 6 mg injection every 2 weeks EFPE_SC_6MG_Q2W | -0.04 (-9.47 to 9.54) | -13.59 to 13.70 | -0.20 (-3.95 to 3.55) | Unclear |
Ranking
League table
| Row versus column | PLACEBO | MAZD_SC_6MG_QW | SEMA_SC_2p4MG_QW | EXENER_SC_2-10MG_QW | LIRA_SC_2p4MG_QD | EFPE_SC_6MG_QW | MAZD_SC_4p5MG_QW | LIRA_SC_3p0MG_QD | MAZD_SC_3MG_QW | LIRA_SC_1p2MG_QD | EFPE_SC_4MG_QW | EFPE_SC_8MG_Q2W | LIRA_SC_1p8MG_QD | ORLISTAT | SEMA_SC_1p0MG_QW | EFPE_SC_6MG_Q2W |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PLACEBO | PLACEBO | 9.61 -0.87 to 18.70 | 6.94 -5.51 to 18.90 | 6.64 -4.71 to 17.50 | 6.45 -2.63 to 15.65 | 5.86 -4.13 to 15.20 | 4.95 -5.32 to 14.30 | 4.45 -2.75 to 12.56 | 4.07 -6.37 to 13.48 | 3.45 -5.82 to 12.97 | 3.28 -7.07 to 12.87 | 2.70 -7.21 to 12.28 | 2.16 -7.35 to 11.63 | 1.72 -7.75 to 10.95 | 1.40 -8.37 to 11.31 | 0.04 -9.54 to 9.47 |
| MAZD_SC_6MG_QW | -9.61 -18.70 to 0.87 | MAZD_SC_6MG_QW | -2.59 -17.55 to 13.68 | -2.97 -17.87 to 12.15 | -3.13 -15.62 to 10.97 | -3.76 -17.17 to 10.85 | -4.68 -14.05 to 5.37 | -5.13 -16.61 to 8.86 | -5.54 -15.52 to 4.29 | -6.12 -18.87 to 8.30 | -6.33 -19.55 to 8.00 | -6.86 -20.13 to 7.28 | -7.41 -20.45 to 6.74 | -7.84 -20.28 to 6.49 | -8.17 -21.99 to 6.55 | -9.53 -23.26 to 4.89 |
| SEMA_SC_2p4MG_QW | -6.94 -18.90 to 5.51 | 2.59 -13.68 to 17.55 | SEMA_SC_2p4MG_QW | -0.30 -17.23 to 16.25 | -0.48 -15.49 to 15.19 | -1.19 -16.63 to 14.58 | -1.98 -17.64 to 13.42 | -2.46 -15.73 to 12.64 | -2.94 -18.62 to 12.89 | -3.56 -18.30 to 11.96 | -3.73 -19.53 to 11.78 | -4.25 -19.88 to 11.87 | -4.86 -20.00 to 11.43 | -5.37 -20.12 to 10.33 | -5.52 -21.60 to 10.72 | -6.90 -22.69 to 8.58 |
| EXENER_SC_2-10MG_QW | -6.64 -17.50 to 4.71 | 2.97 -12.15 to 17.87 | 0.30 -16.25 to 17.23 | EXENER_SC_2-10MG_QW | -0.16 -13.99 to 14.14 | -0.91 -15.92 to 13.74 | -1.82 -16.88 to 12.81 | -2.27 -14.46 to 12.07 | -2.75 -17.26 to 12.20 | -3.21 -17.59 to 11.74 | -3.44 -18.61 to 11.37 | -3.89 -18.90 to 11.04 | -4.51 -18.09 to 9.79 | -4.93 -19.66 to 10.00 | -5.31 -20.06 to 9.54 | -6.61 -21.45 to 8.37 |
| LIRA_SC_2p4MG_QD | -6.45 -15.65 to 2.63 | 3.13 -10.97 to 15.62 | 0.48 -15.19 to 15.49 | 0.16 -14.14 to 13.99 | LIRA_SC_2p4MG_QD | -0.61 -14.83 to 12.23 | -1.52 -15.47 to 11.03 | -2.03 -11.33 to 7.79 | -2.48 -16.07 to 10.57 | -2.96 -13.30 to 7.76 | -3.18 -17.16 to 9.71 | -3.74 -18.13 to 8.79 | -4.27 -14.30 to 5.73 | -4.77 -14.97 to 5.71 | -5.07 -18.85 to 8.28 | -6.45 -20.14 to 6.84 |
| EFPE_SC_6MG_QW | -5.86 -15.20 to 4.13 | 3.76 -10.85 to 17.17 | 1.19 -14.58 to 16.63 | 0.91 -13.74 to 15.92 | 0.61 -12.23 to 14.83 | EFPE_SC_6MG_QW | -0.93 -14.78 to 12.31 | -1.40 -13.04 to 11.83 | -1.84 -15.88 to 11.82 | -2.39 -15.60 to 11.79 | -2.61 -12.60 to 7.62 | -3.09 -13.75 to 7.04 | -3.68 -17.05 to 10.50 | -4.15 -17.09 to 10.39 | -4.50 -17.89 to 9.70 | -5.83 -16.01 to 4.45 |
| MAZD_SC_4p5MG_QW | -4.95 -14.30 to 5.32 | 4.68 -5.37 to 14.05 | 1.98 -13.42 to 17.64 | 1.82 -12.81 to 16.88 | 1.52 -11.03 to 15.47 | 0.93 -12.31 to 14.78 | MAZD_SC_4p5MG_QW | -0.51 -11.64 to 13.18 | -0.84 -11.19 to 9.15 | -1.52 -14.01 to 12.87 | -1.73 -14.99 to 12.17 | -2.19 -15.36 to 11.47 | -2.75 -15.62 to 10.76 | -3.27 -15.76 to 10.59 | -3.58 -16.73 to 11.02 | -4.91 -17.90 to 9.22 |
| LIRA_SC_3p0MG_QD | -4.45 -12.56 to 2.75 | 5.13 -8.86 to 16.61 | 2.46 -12.64 to 15.73 | 2.27 -12.07 to 14.46 | 2.03 -7.79 to 11.33 | 1.40 -11.83 to 13.04 | 0.51 -13.18 to 11.64 | LIRA_SC_3p0MG_QD | -0.52 -13.79 to 11.34 | -0.94 -11.15 to 8.54 | -1.20 -14.29 to 10.60 | -1.67 -15.07 to 9.66 | -2.28 -12.17 to 6.60 | -2.71 -13.13 to 6.42 | -2.98 -15.87 to 8.81 | -4.37 -17.54 to 7.22 |
| MAZD_SC_3MG_QW | -4.07 -13.48 to 6.37 | 5.54 -4.29 to 15.52 | 2.94 -12.89 to 18.62 | 2.75 -12.20 to 17.26 | 2.48 -10.57 to 16.07 | 1.84 -11.82 to 15.88 | 0.84 -9.15 to 11.19 | 0.52 -11.34 to 13.79 | MAZD_SC_3MG_QW | -0.53 -13.72 to 13.47 | -0.77 -14.51 to 13.07 | -1.30 -15.18 to 12.44 | -1.86 -15.04 to 12.24 | -2.36 -15.23 to 11.67 | -2.62 -16.11 to 12.04 | -4.00 -17.71 to 10.40 |
| LIRA_SC_1p2MG_QD | -3.45 -12.97 to 5.82 | 6.12 -8.30 to 18.87 | 3.56 -11.96 to 18.30 | 3.21 -11.74 to 17.59 | 2.96 -7.76 to 13.30 | 2.39 -11.79 to 15.60 | 1.52 -12.87 to 14.01 | 0.94 -8.54 to 11.15 | 0.53 -13.47 to 13.72 | LIRA_SC_1p2MG_QD | -0.22 -14.24 to 13.32 | -0.65 -15.16 to 12.05 | -1.31 -11.69 to 9.15 | -1.80 -11.83 to 8.67 | -2.13 -16.08 to 11.64 | -3.42 -17.55 to 9.81 |
| EFPE_SC_4MG_QW | -3.28 -12.87 to 7.07 | 6.33 -8.00 to 19.55 | 3.73 -11.78 to 19.53 | 3.44 -11.37 to 18.61 | 3.18 -9.71 to 17.16 | 2.61 -7.62 to 12.60 | 1.73 -12.17 to 14.99 | 1.20 -10.60 to 14.29 | 0.77 -13.07 to 14.51 | 0.22 -13.32 to 14.24 | EFPE_SC_4MG_QW | -0.48 -10.68 to 9.40 | -1.08 -14.52 to 12.71 | -1.49 -14.74 to 12.11 | -1.83 -15.28 to 11.82 | -3.19 -12.75 to 6.30 |
| EFPE_SC_8MG_Q2W | -2.70 -12.28 to 7.21 | 6.86 -7.28 to 20.13 | 4.25 -11.87 to 19.88 | 3.89 -11.04 to 18.90 | 3.74 -8.79 to 18.13 | 3.09 -7.04 to 13.75 | 2.19 -11.47 to 15.36 | 1.67 -9.66 to 15.07 | 1.30 -12.44 to 15.18 | 0.65 -12.05 to 15.16 | 0.48 -9.40 to 10.68 | EFPE_SC_8MG_Q2W | -0.58 -13.62 to 13.45 | -1.02 -13.65 to 12.49 | -1.32 -14.66 to 12.43 | -2.71 -12.66 to 7.65 |
| LIRA_SC_1p8MG_QD | -2.16 -11.63 to 7.35 | 7.41 -6.74 to 20.45 | 4.86 -11.43 to 20.00 | 4.51 -9.79 to 18.09 | 4.27 -5.73 to 14.30 | 3.68 -10.50 to 17.05 | 2.75 -10.76 to 15.62 | 2.28 -6.60 to 12.17 | 1.86 -12.24 to 15.04 | 1.31 -9.15 to 11.69 | 1.08 -12.71 to 14.52 | 0.58 -13.45 to 13.62 | LIRA_SC_1p8MG_QD | -0.44 -10.50 to 9.62 | -0.72 -14.40 to 12.59 | -2.11 -16.02 to 11.27 |
| ORLISTAT | -1.72 -10.95 to 7.75 | 7.84 -6.49 to 20.28 | 5.37 -10.33 to 20.12 | 4.93 -10.00 to 19.66 | 4.77 -5.71 to 14.97 | 4.15 -10.39 to 17.09 | 3.27 -10.59 to 15.76 | 2.71 -6.42 to 13.13 | 2.36 -11.67 to 15.23 | 1.80 -8.67 to 11.83 | 1.49 -12.11 to 14.74 | 1.02 -12.49 to 13.65 | 0.44 -9.62 to 10.50 | ORLISTAT | -0.29 -13.58 to 12.98 | -1.67 -15.47 to 11.79 |
| SEMA_SC_1p0MG_QW | -1.40 -11.31 to 8.37 | 8.17 -6.55 to 21.99 | 5.52 -10.72 to 21.60 | 5.31 -9.54 to 20.06 | 5.07 -8.28 to 18.85 | 4.50 -9.70 to 17.89 | 3.58 -11.02 to 16.73 | 2.98 -8.81 to 15.87 | 2.62 -12.04 to 16.11 | 2.13 -11.64 to 16.08 | 1.83 -11.82 to 15.28 | 1.32 -12.43 to 14.66 | 0.72 -12.59 to 14.40 | 0.29 -12.98 to 13.58 | SEMA_SC_1p0MG_QW | -1.39 -14.90 to 12.46 |
| EFPE_SC_6MG_Q2W | -0.04 -9.47 to 9.54 | 9.53 -4.89 to 23.26 | 6.90 -8.58 to 22.69 | 6.61 -8.37 to 21.45 | 6.45 -6.84 to 20.14 | 5.83 -4.45 to 16.01 | 4.91 -9.22 to 17.90 | 4.37 -7.22 to 17.54 | 4.00 -10.40 to 17.71 | 3.42 -9.81 to 17.55 | 3.19 -6.30 to 12.75 | 2.71 -7.65 to 12.66 | 2.11 -11.27 to 16.02 | 1.67 -11.79 to 15.47 | 1.39 -12.46 to 14.90 | EFPE_SC_6MG_Q2W |
Heterogeneity, fit and convergence
Bayesian random effects (primary)
Frequentist check (netmeta)
Inconsistency
No comparison here has both direct and indirect evidence, so inconsistency cannot be checked by node splitting; the between designs Q above is the global check.
Small study effects
Fewer than ten trial comparisons, too few to judge funnel plot asymmetry.
Baseline characteristics of the trials
| Trial | Baseline BMI or body weight (kg/m2) effect modifier, prognostic factor; 7 of 7 |
|---|---|
| BARI-STEP S000434 | 41.5 |
| BARIOPTIMISE S000466 | 43.1 |
| NCT02075281 S000743 | 35.44 |
| NCT04904913 S001183 | 31.83 |
| Dapalost S001235 | 35.4 |
| HISTORI S001361 | 40.41 |
| NCT00422058 S001402 | 34.76 |
Comparability of the trials
- FlagBaseline, Baseline BMI or body weight: design means range from 31.8 (MAZD_SC_3MG_QW vs MAZD_SC_4p5MG_QW vs MAZD_SC_6MG_QW vs PLACEBO) to 43.1 (LIRA_SC_3p0MG_QD vs PLACEBO) kg/m2; threshold 3
- FlagHeterogeneity, tau above threshold: tau 3.06 exceeds the outcome threshold 2; the flags of this network are candidate explanations
- NoteOutcome assessment, time point: selected time points span 20 to 32 weeks
- NoteOutcome assessment, analysis set: mixed: full_analysis 1, modified_itt 4, randomized 1, safety 1
- NoteRisk of bias, funding: mixed: industry 4, mixed 3
- NoteData handling, input conversions: n_randomized 4
| Trial | time weeks | analysis set | definition | instrument | adjudicated | proportion method | intercurrent events (discontinuation) | intercurrent events (rescue) | blinding | funding | start year | Eligibility |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BARI-STEP | 32 | randomized | not stated | not stated | not stated | not stated | not stated | not stated | double_blind | mixed | 2022 | age 18 to 65; at least 1 year after primary bypass or sleeve; less than 20 percent weight loss from surgery |
| BARIOPTIMISE | 24 | modified_itt | not stated | not stated | not stated | not stated | not stated | not stated | double_blind | mixed | 2018 | adults at least 1 year after RYGB or sleeve gastrectomy with 20 percent or less weight loss and suboptimal GLP-1 response |
| NCT02075281 | 20 | safety | not stated | not stated | not stated | not stated | not stated | not stated | double_blind | industry | 2014 | age 18 to 64 years; BMI 30 to 42, or 27 to 30 with comorbidity; FPG below 7 mmol/L; HbA1c 6.5 percent or less; no diabetes |
| NCT04904913 | 24 | modified_itt | not stated | not stated | not stated | not stated | not stated | not stated | double_blind | industry | 2021 | Chinese adults 18 to 75; BMI 28 or more, or 24 or more with comorbidity or hyperphagia; no diabetes, HbA1c below 6.5 |
| Dapalost | 24 | full_analysis | not stated | not stated | not stated | not stated | not stated | not stated | double_blind | industry | 2014 | age 18 to 70; BMI 30 to 45 kg/m2; no diabetes |
| HISTORI | 30 | modified_itt | not stated | not stated | not stated | not stated | not stated | not stated | double_blind | mixed | 2022 | age 18 to 60; schizophrenia spectrum on SGA; BMI 27 or more; HbA1c 39 to 47 mmol/mol; no diabetes |
| NCT00422058 | 20 | modified_itt | not stated | not stated | not stated | not stated | not stated | not stated | double_blind | industry | 2007 | age 18 to 65; BMI 30 to 40; FPG below 7 mmol/L; no diabetes |
Trial data
| Trial | Arm | Treatment | Week | Data | Value | SE | Events / N | Flags | Source |
|---|---|---|---|---|---|---|---|---|---|
| BARI-STEP | A1 | PLACEBO | 32 | arm, change | 5.010 | 3.100 | 30 | R0014003:Supplement Table 3 | |
| BARI-STEP | A2 | SEMA_SC_2p4MG_QW | 32 | arm, change | -2.170 | 3.140 | 34 | R0014003:Supplement Table 3 | |
| BARIOPTIMISE | A1 | PLACEBO | 24 | arm, change | 2.340 | 3.346 | 32 | R0017334:Table 2 | |
| BARIOPTIMISE | A2 | LIRA_SC_3p0MG_QD | 24 | arm, change | -6.280 | 2.899 | 32 | R0017334:Table 2 | |
| NCT02075281 | A1 | PLACEBO | 20 | arm, change | -0.100 | 1.300 | 48 | R0011218:Supplement Table S7 | |
| NCT02075281 | A2 | EFPE_SC_4MG_QW | 20 | arm, change | -3.500 | 1.400 | 44 | R0011218:Supplement Table S7 | |
| NCT02075281 | A3 | EFPE_SC_6MG_QW | 20 | arm, change | -6.100 | 1.400 | 42 | R0011218:Supplement Table S7 | |
| NCT02075281 | A4 | EFPE_SC_6MG_Q2W | 20 | arm, change | -0.300 | 1.400 | 41 | R0011218:Supplement Table S7 | |
| NCT02075281 | A5 | EFPE_SC_8MG_Q2W | 20 | arm, change | -3.000 | 1.400 | 40 | R0011218:Supplement Table S7 | |
| NCT04904913 | A1 | MAZD_SC_3MG_QW | 24 | arm, change | -1.300 | 1.300 | 62 | R0016107:Table 3 | |
| NCT04904913 | A2 | MAZD_SC_4p5MG_QW | 24 | arm, change | -2.200 | 1.200 | 63 | R0016107:Table 3 | |
| NCT04904913 | A3 | MAZD_SC_6MG_QW | 24 | arm, change | -6.900 | 1.200 | 61 | R0016107:Table 3 | |
| NCT04904913 | A4 | PLACEBO | 24 | arm, change | 2.900 | 1.200 | 62 | R0016107:Table 3 | |
| Dapalost | A1 | EXENER_SC_2-10MG_QW | 24 | arm, change | -9.800 | 2.015 | 25 | n_randomized | R0025222:Table 1 |
| Dapalost | A2 | PLACEBO | 24 | arm, change | -3.000 | 2.117 | 25 | n_randomized | R0025627:Table 2 |
| HISTORI | A1 | SEMA_SC_1p0MG_QW | 30 | arm, change | -1.610 | 1.000 | 77 | n_randomized | R0014539:Table 2 |
| HISTORI | A2 | PLACEBO | 30 | arm, change | -0.230 | 1.538 | 77 | n_randomized | R0014539:Table 2 |
| NCT00422058 | A1 | PLACEBO | 20 | arm, change | -3.200 | 1.372 | 94 | registry:outcomes | |
| NCT00422058 | A2 | LIRA_SC_1p2MG_QD | 20 | arm, change | -6.100 | 1.183 | 88 | registry:outcomes | |
| NCT00422058 | A3 | LIRA_SC_1p8MG_QD | 20 | arm, change | -4.800 | 1.378 | 85 | registry:outcomes | |
| NCT00422058 | A4 | LIRA_SC_2p4MG_QD | 20 | arm, change | -9.100 | 1.304 | 89 | registry:outcomes | |
| NCT00422058 | A5 | LIRA_SC_3p0MG_QD | 20 | arm, change | -6.400 | 1.060 | 89 | registry:outcomes | |
| NCT00422058 | A6 | ORLISTAT | 20 | arm, change | -4.300 | 1.149 | 90 | registry:outcomes |
Rerun this analysis yourself
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