LivingGLP1
Network meta-analysis

Weight loss of 10 percent or more

Overweight or obesity without diabetes (adults)

weeks 40 to 104 (target week 68)Not stated by the trialsEach dose separatelyOdds ratioSeparate part 2 of a disconnected network
11
Randomized trials
14
Treatments
3,569
Participants
1,677
Events

In plain language

Across 11 trials with 3,569 participants, 9 of 13 treatments had a clearly better result than placebo on weight loss of 10 percent or more, and for 4 the evidence could not tell them apart from placebo. The most favorable estimate was for Semaglutide and bimagrumab 2.4 to 30 mg injection once weekly: odds ratio 65.67 (95% credible interval 14.59 to 356).

Higher 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

Each circle is a treatment; each line joins treatments that were randomized against each other in at least one trial.
BIMASEMA_SC_1p0-10MG_QWBIMASEMA_SC_1p0-30MG_QWBIMASEMA_SC_2p4-10MG_QWBIMASEMA_SC_2p4-30MG_QWLIRA_SC_3p0MG_QDOTHER_ACTIVE_bimagrumabPLACEBOSEMA_PO_50MG_QDSEMA_SC_1p0MG_QWSEMA_SC_1p7MG_QWSEMA_SC_2p4MG_QWSTANDARD_CARETIRZ_SC_10MG_QWTIRZ_SC_15MG_QW
Node area shows participants; line width shows trials comparing two treatments directly. Blue: GLP-1 receptor agonist containing treatments; grey: comparators. Hover over or tab to a node or line for details.

Effects compared with Placebo

Odds ratio. Higher values favor the treatment.
0.050.10.20.250.51245102050100← favors referencefavors treatment →Semaglutide and bimagrumab 2.4 t…Semaglutide and bimagrumab 2.4 t…Semaglutide and bimagrumab 1.0 t…Semaglutide 2.4 mg subcutaneous …Semaglutide 50 mg oral once dail…Semaglutide and bimagrumab 1.0 t…Semaglutide 1.7 mg injection onc…Tirzepatide 15 mg subcutaneous o…Semaglutide 1.0 mg subcutaneous …Tirzepatide 10 mg subcutaneous o…BimagrumabLiraglutide 3.0 mg subcutaneous …Standard care or no added treatm…
Versus Placebo, log scale. Blue: Bayesian random effects posterior median with 95% credible interval (thick) and 95% prediction interval (dashed). Amber diamond: frequentist estimate with 95% confidence interval. Hover over or tab to a row for its values.
Effects of each treatment versus Placebo
TreatmentBayesian OR (95% CrI)95% prediction intervalFrequentist OR (95% CI)Verdict
Semaglutide and bimagrumab 2.4 to 30 mg injection once weekly
BIMASEMA_SC_2p4-30MG_QW
65.67 (14.59 to 356)10.57 to 463122 (20.58 to 720)Better
Semaglutide and bimagrumab 2.4 to 10 mg injection once weekly
BIMASEMA_SC_2p4-10MG_QW
43.43 (10.55 to 197)7.34 to 24973.21 (14.93 to 359)Better
Semaglutide and bimagrumab 1.0 to 30 mg injection once weekly
BIMASEMA_SC_1p0-30MG_QW
16.73 (4.66 to 55.03)3.26 to 75.7825.97 (6.96 to 96.92)Better
Semaglutide 2.4 mg subcutaneous once weekly
SEMA_SC_2p4MG_QW
16.62 (11.07 to 26.51)5.68 to 50.9718.17 (11.59 to 28.49)Better
Semaglutide 50 mg oral once daily (higher dose oral program)
SEMA_PO_50MG_QD
15.53 (4.81 to 40.80)3.16 to 60.5516.85 (6.01 to 47.26)Better
Semaglutide and bimagrumab 1.0 to 10 mg injection once weekly
BIMASEMA_SC_1p0-10MG_QW
8.35 (2.40 to 26.17)1.63 to 36.7512.79 (3.64 to 44.89)Better
Semaglutide 1.7 mg injection once weekly
SEMA_SC_1p7MG_QW
8.29 (3.07 to 23.29)2.04 to 34.799.77 (3.47 to 27.52)Better
Tirzepatide 15 mg subcutaneous once weekly
TIRZ_SC_15MG_QW
5.36 (1.36 to 20.11)1.00 to 27.686.22 (1.54 to 25.16)Better
Semaglutide 1.0 mg subcutaneous once weekly
SEMA_SC_1p0MG_QW
3.80 (1.13 to 11.29)0.76 to 16.095.68 (1.68 to 19.21)Better
Tirzepatide 10 mg subcutaneous once weekly
TIRZ_SC_10MG_QW
3.54 (0.94 to 13.51)0.66 to 18.094.08 (1.02 to 16.37)Unclear
Bimagrumab
OTHER_ACTIVE_bimagrumab
2.77 (0.90 to 7.87)0.63 to 11.244.16 (1.28 to 13.44)Unclear
Liraglutide 3.0 mg subcutaneous once daily
LIRA_SC_3p0MG_QD
2.16 (0.81 to 5.62)0.53 to 8.492.26 (0.82 to 6.22)Unclear
Standard care or no added treatment
STANDARD_CARE
0.29 (0.07 to 1.31)0.05 to 1.740.30 (0.06 to 1.43)Unclear

Ranking

How likely each treatment is to be among the best. Rankings ignore the size of differences and their certainty, so read them with the effects above.

League table

Every treatment against every other: odds ratio of the row treatment versus the column treatment, posterior median and 95% credible interval. Green: row clearly better; red: row clearly worse.
Every treatment in a row compared with every treatment in a column
Row versus columnPLACEBOBIMASEMA_SC_2p4-30MG_QWBIMASEMA_SC_2p4-10MG_QWBIMASEMA_SC_1p0-30MG_QWSEMA_SC_2p4MG_QWSEMA_PO_50MG_QDBIMASEMA_SC_1p0-10MG_QWSEMA_SC_1p7MG_QWTIRZ_SC_15MG_QWSEMA_SC_1p0MG_QWTIRZ_SC_10MG_QWOTHER_ACTIVE_bimagrumabLIRA_SC_3p0MG_QDSTANDARD_CARE
PLACEBOPLACEBO0.02
0.00 to 0.07
0.02
0.01 to 0.09
0.06
0.02 to 0.21
0.06
0.04 to 0.09
0.06
0.02 to 0.21
0.12
0.04 to 0.42
0.12
0.04 to 0.33
0.19
0.05 to 0.73
0.26
0.09 to 0.88
0.28
0.07 to 1.07
0.36
0.13 to 1.11
0.46
0.18 to 1.24
3.42
0.77 to 14.86
BIMASEMA_SC_2p4-30MG_QW65.67
14.59 to 356
BIMASEMA_SC_2p4-30MG_QW1.52
0.22 to 11.04
3.93
0.78 to 25.15
3.95
0.83 to 21.76
4.31
0.73 to 31.56
7.88
1.49 to 49.39
8.07
1.28 to 53.90
12.49
1.67 to 96.48
17.71
3.43 to 109
18.89
2.70 to 144
23.72
4.81 to 142
31.02
4.85 to 213
232
25.45 to 1896
BIMASEMA_SC_2p4-10MG_QW43.43
10.55 to 197
0.66
0.09 to 4.55
BIMASEMA_SC_2p4-10MG_QW2.63
0.55 to 13.88
2.62
0.60 to 11.61
2.87
0.51 to 18.06
5.19
1.12 to 28.41
5.34
0.86 to 29.56
8.13
1.14 to 58.38
11.69
2.46 to 60.03
12.43
1.70 to 82.87
15.67
3.68 to 81.01
20.38
3.69 to 119
150
17.44 to 1153
BIMASEMA_SC_1p0-30MG_QW16.73
4.66 to 55.03
0.25
0.04 to 1.29
0.38
0.07 to 1.83
BIMASEMA_SC_1p0-30MG_QW1.01
0.27 to 3.34
1.09
0.23 to 5.42
2.00
0.51 to 8.10
2.02
0.39 to 8.84
3.11
0.50 to 18.56
4.43
1.13 to 16.89
4.71
0.76 to 26.92
6.05
1.68 to 22.20
7.83
1.57 to 34.64
57.84
7.74 to 353
SEMA_SC_2p4MG_QW16.62
11.07 to 26.51
0.25
0.05 to 1.20
0.38
0.09 to 1.66
0.99
0.30 to 3.74
SEMA_SC_2p4MG_QW1.06
0.38 to 3.94
1.99
0.63 to 7.35
2.00
0.75 to 5.58
3.11
0.77 to 13.55
4.36
1.49 to 15.40
4.70
1.20 to 18.90
5.98
2.17 to 19.57
7.72
3.06 to 21.43
56.25
13.06 to 259
SEMA_PO_50MG_QD15.53
4.81 to 40.80
0.23
0.03 to 1.38
0.35
0.06 to 1.95
0.92
0.18 to 4.43
0.94
0.25 to 2.61
SEMA_PO_50MG_QD1.87
0.36 to 9.18
1.87
0.38 to 7.48
2.89
0.50 to 15.36
4.06
0.87 to 18.11
4.36
0.78 to 21.93
5.51
1.17 to 24.65
7.13
1.50 to 27.24
52.55
7.46 to 309
BIMASEMA_SC_1p0-10MG_QW8.35
2.40 to 26.17
0.13
0.02 to 0.67
0.19
0.04 to 0.90
0.50
0.12 to 1.95
0.50
0.14 to 1.59
0.53
0.11 to 2.74
BIMASEMA_SC_1p0-10MG_QW1.01
0.21 to 4.32
1.58
0.25 to 9.12
2.22
0.59 to 8.37
2.40
0.39 to 13.29
3.03
0.84 to 10.97
3.92
0.83 to 16.85
28.78
3.96 to 173
SEMA_SC_1p7MG_QW8.29
3.07 to 23.29
0.12
0.02 to 0.78
0.19
0.03 to 1.17
0.50
0.11 to 2.56
0.50
0.18 to 1.34
0.53
0.13 to 2.63
0.99
0.23 to 4.78
SEMA_SC_1p7MG_QW1.53
0.30 to 8.54
2.17
0.53 to 10.48
2.34
0.44 to 12.12
2.97
0.77 to 13.75
3.86
1.05 to 14.41
28.28
4.71 to 160
TIRZ_SC_15MG_QW5.36
1.36 to 20.11
0.08
0.01 to 0.60
0.12
0.02 to 0.88
0.32
0.05 to 1.98
0.32
0.07 to 1.29
0.35
0.07 to 1.99
0.63
0.11 to 3.97
0.65
0.12 to 3.38
TIRZ_SC_15MG_QW1.40
0.26 to 8.10
1.51
0.43 to 5.18
1.93
0.36 to 10.87
2.47
0.47 to 12.64
18.46
2.48 to 128
SEMA_SC_1p0MG_QW3.80
1.13 to 11.29
0.06
0.01 to 0.29
0.09
0.02 to 0.41
0.23
0.06 to 0.88
0.23
0.06 to 0.67
0.25
0.06 to 1.15
0.45
0.12 to 1.71
0.46
0.10 to 1.87
0.71
0.12 to 3.78
SEMA_SC_1p0MG_QW1.06
0.19 to 5.58
1.36
0.41 to 4.69
1.75
0.39 to 7.37
12.90
1.83 to 75.58
TIRZ_SC_10MG_QW3.54
0.94 to 13.51
0.05
0.01 to 0.37
0.08
0.01 to 0.59
0.21
0.04 to 1.31
0.21
0.05 to 0.83
0.23
0.05 to 1.28
0.42
0.08 to 2.58
0.43
0.08 to 2.26
0.66
0.19 to 2.33
0.94
0.18 to 5.36
TIRZ_SC_10MG_QW1.28
0.24 to 7.14
1.64
0.31 to 8.72
12.25
1.69 to 84.13
OTHER_ACTIVE_bimagrumab2.77
0.90 to 7.87
0.04
0.01 to 0.21
0.06
0.01 to 0.27
0.17
0.05 to 0.59
0.17
0.05 to 0.46
0.18
0.04 to 0.86
0.33
0.09 to 1.18
0.34
0.07 to 1.30
0.52
0.09 to 2.78
0.73
0.21 to 2.46
0.78
0.14 to 4.09
OTHER_ACTIVE_bimagrumab1.30
0.29 to 5.17
9.48
1.44 to 57.53
LIRA_SC_3p0MG_QD2.16
0.81 to 5.62
0.03
0.00 to 0.21
0.05
0.01 to 0.27
0.13
0.03 to 0.64
0.13
0.05 to 0.33
0.14
0.04 to 0.67
0.26
0.06 to 1.20
0.26
0.07 to 0.95
0.40
0.08 to 2.14
0.57
0.14 to 2.57
0.61
0.11 to 3.19
0.77
0.19 to 3.41
LIRA_SC_3p0MG_QD7.38
2.21 to 23.97
STANDARD_CARE0.29
0.07 to 1.31
0.00
0.00 to 0.04
0.01
0.00 to 0.06
0.02
0.00 to 0.13
0.02
0.00 to 0.08
0.02
0.00 to 0.13
0.03
0.01 to 0.25
0.04
0.01 to 0.21
0.05
0.01 to 0.40
0.08
0.01 to 0.55
0.08
0.01 to 0.59
0.11
0.02 to 0.69
0.14
0.04 to 0.45
STANDARD_CARE

Heterogeneity, fit and convergence

Bayesian random effects (primary)

Heterogeneity (tau)
0.407 (95% CrI 0.129 to 0.929), log scale
Residual deviance
33.3 for 31 data points
DIC
59.5 (pD 26.2)
Largest R-hat
1.002
Smallest ESS
bulk 2,210, tail 3,779
Divergent transitions
0
Convergence
All criteria met
Priors
PR02 N(0, 5^2); PR05 N(0, 2.5^2); PR09 log normal(-2.53, 1.58^2) on tau^2 (General physical health indicators, pharm vs pharm)

Frequentist check (netmeta)

Method
inverse variance, REML, OR
Tau
0.479
I squared
63%
Q (total)
18.70 on 7 df, P = 0.009
Q (between designs)
5.78, P = 0.123

Inconsistency

Do trials comparing two treatments directly agree with the indirect evidence through other treatments?

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

A comparison adjusted funnel plot: each point is one trial comparison, centered on its own network estimate. Asymmetry can signal that small trials with unfavorable results are missing.

Fewer than ten trial comparisons, too few to judge funnel plot asymmetry.

Baseline characteristics of the trials

The baseline value of each effect modifier or prognostic factor that applies here, per trial: mean or percent over arms, weighted by the number randomized. A note under a value names a stand in (a median for a mean, 100 minus the male share, Asian subgroup rows, an all Asian site list); "not reported" means no source of the trial prints it.
Baseline effect modifiers and prognostic factors per trial
TrialBaseline BMI or body weight (kg/m2)
effect modifier, prognostic factor; 6 of 11
Type 2 diabetes share in weight trials (percent of participants)
effect modifier; 11 of 11
Sex (percent female)
effect modifier, prognostic factor; 11 of 11
Treatment duration (weeks)
effect modifier; 11 of 11
Lifestyle co-intervention intensity (none standard intensive)
effect modifier, prognostic factor; 11 of 11
STEP 5
S000214
38.550
population codes
77.6104standard
BARI-STEP
S000434
41.51082.8568standard
NCT05616013
S000715
37.30
population codes
57.3748standard
STEP 10
S000832
39.90
population codes
71.0152not_reported
STEP 3
S000988
380
population codes
81.0168intensive
SURMOUNT-CN
S001086
body weight 91.8 kg
0
population codes
49.0552standard
STEP7
S001288
not reported0
population codes
45.3344standard
OASIS 1
S001472
not reported0
population codes
72.7168not_reported
STEP 8
S001600
not reported0
population codes
78.468standard
STRIVE
S001687
45.9635.564.28104intensive
STEP 6
S002102
not reported0
population codes
36.9168not_reported

Comparability of the trials

Checked across designs (the set of treatments each trial compares) for eligibility, outcome definition and assessment, and the baseline factors above. Flags point to possible intransitivity; notes describe variation that is not tied to design.
  • FlagBaseline, Baseline BMI or body weight: not reported by 5 of 11 trials
  • FlagBaseline, Baseline BMI or body weight: design means range from 37.3 (BIMASEMA_SC_1p0-10MG_QW vs BIMASEMA_SC_1p0-30MG_QW vs BIMASEMA_SC_2p4-10MG_QW vs BIMASEMA_SC_2p4-30MG_QW vs OTHER_ACTIVE_bimagrumab vs PLACEBO vs SEMA_SC_1p0MG_QW vs SEMA_SC_2p4MG_QW) to 46.0 (LIRA_SC_3p0MG_QD vs STANDARD_CARE) kg/m2; threshold 3
  • FlagBaseline, Type 2 diabetes share in weight trials: design means range from 0.0 (BIMASEMA_SC_1p0-10MG_QW vs BIMASEMA_SC_1p0-30MG_QW vs BIMASEMA_SC_2p4-10MG_QW vs BIMASEMA_SC_2p4-30MG_QW vs OTHER_ACTIVE_bimagrumab vs PLACEBO vs SEMA_SC_1p0MG_QW vs SEMA_SC_2p4MG_QW) to 35.5 (LIRA_SC_3p0MG_QD vs STANDARD_CARE) percent of participants; threshold 20
  • FlagBaseline, Sex: design means range from 36.9 (PLACEBO vs SEMA_SC_1p7MG_QW vs SEMA_SC_2p4MG_QW) to 78.4 (LIRA_SC_3p0MG_QD vs PLACEBO vs SEMA_SC_2p4MG_QW) percent female; threshold 15
  • FlagBaseline, Treatment duration: design means range from 48.0 (BIMASEMA_SC_1p0-10MG_QW vs BIMASEMA_SC_1p0-30MG_QW vs BIMASEMA_SC_2p4-10MG_QW vs BIMASEMA_SC_2p4-30MG_QW vs OTHER_ACTIVE_bimagrumab vs PLACEBO vs SEMA_SC_1p0MG_QW vs SEMA_SC_2p4MG_QW) to 104.0 (LIRA_SC_3p0MG_QD vs STANDARD_CARE) weeks; threshold 26
  • NoteOutcome assessment, time point: selected time points span 44 to 78 weeks
  • NoteOutcome assessment, analysis set: mixed: completers 3, full_analysis 7, modified_itt 1
  • NoteOutcome assessment, proportion method: mixed: not stated 9, observed 2
  • NoteRisk of bias, blinding: mixed: double_blind 9, open_label 2
  • NoteRisk of bias, funding: mixed: industry 10, mixed 1
  • NoteData handling, input conversions: arms_combined 1, count_from_percent 11
Comparability items per trial
Trialtime weeksanalysis setdefinitioninstrumentadjudicatedproportion methodintercurrent events (discontinuation)intercurrent events (rescue)blindingfundingstart yearEligibility
STEP 552full_analysisnot statednot statednot statednot statednot statednot stateddouble_blindindustry2018age 18 or older; BMI 30 or more, or 27 or more with comorbidity; no diabetes; HbA1c below 6.5 percent
BARI-STEP68modified_ittnot statednot statednot statednot statednot statednot stateddouble_blindmixed2022age 18 to 65; at least 1 year after primary bypass or sleeve; less than 20 percent weight loss from surgery
NCT0561601348completersnot statednot statednot statedobservednot statednot statedopen_labelindustry2022adults 18 to 80; BMI 30 or more, or 27 or more with comorbidity; no diabetes (HbA1c below 6.5 percent); weight below 150 kg
STEP 1052full_analysisnot statednot statednot statednot statednot statednot stateddouble_blindindustry2021Adults with obesity and prediabetes; diabetes excluded
STEP 368full_analysisnot statednot statednot statednot statednot statednot stateddouble_blindindustry2018BMI 30 or more, or 27 with comorbidity; no type 2 diabetes
SURMOUNT-CN78completersnot statednot statednot statedobservednot statednot stateddouble_blindindustry2021Chinese adults; BMI 28 or more, or 24 or more with a weight related comorbidity; no diabetes
STEP744full_analysisnot statednot statednot statednot statednot statednot stateddouble_blindindustry2020age 18 or older; BMI 30 or more, or 27 or more with a weight related comorbidity including T2D
OASIS 168full_analysisnot statednot statednot statednot statednot statednot stateddouble_blindindustry2021overweight or obesity
STEP 868full_analysisnot statednot statednot statednot statednot statednot stateddouble_blindindustry2019age 18 or older; BMI 30 or higher, or 27 with a weight related comorbidity; no type 2 diabetes
STRIVE52completersnot statednot statednot statednot statednot statednot statedopen_labelindustry2017age 18 to 75; BMI 35 or more plus prediabetes, T2D, hypertension or sleep apnea; no insulin or GLP-1 RA
STEP 668full_analysisnot statednot statednot statednot statednot statednot stateddouble_blindindustry2019

Trial data

What each trial contributes. Arm rows give the arm value with its standard error, or events over participants; contrast rows give the odds ratio on the analysis scale (log) against the trial's first row. Flags mark converted, combined or approximated inputs.
Trial data entering this analysis
TrialArmTreatmentWeekDataValueSEEvents / NFlagsSource
STEP 5A1SEMA_SC_2p4MG_QW52arm, responders102 / 149registry:outcomes
STEP 5A2PLACEBO52arm, responders17 / 129registry:outcomes
BARI-STEPA1PLACEBO68arm, responders2 / 29R0014003:Results
BARI-STEPA2SEMA_SC_2p4MG_QW68arm, responders29 / 34R0014003:Results
NCT05616013A1PLACEBO48arm, responders3 / 35count_from_percentregistry:outcomes
NCT05616013A2+A3OTHER_ACTIVE_bimagrumab48arm, responders28 / 68count_from_percent;arms_combinedregistry:outcomes
NCT05616013A4SEMA_SC_1p0MG_QW48arm, responders22 / 45count_from_percentregistry:outcomes
NCT05616013A5SEMA_SC_2p4MG_QW48arm, responders41 / 51count_from_percentregistry:outcomes
NCT05616013A6BIMASEMA_SC_1p0-10MG_QW48arm, responders28 / 41count_from_percentregistry:outcomes
NCT05616013A7BIMASEMA_SC_2p4-10MG_QW48arm, responders37 / 40count_from_percentregistry:outcomes
NCT05616013A8BIMASEMA_SC_1p0-30MG_QW48arm, responders35 / 43count_from_percentregistry:outcomes
NCT05616013A9BIMASEMA_SC_2p4-30MG_QW48arm, responders41 / 43count_from_percentregistry:outcomes
STEP 10A1SEMA_SC_2p4MG_QW52arm, responders95 / 129registry:outcomes
STEP 10A2PLACEBO52arm, responders5 / 66registry:outcomes
STEP 3A1SEMA_SC_2p4MG_QW68arm, responders281 / 373registry:outcomes
STEP 3A2PLACEBO68arm, responders51 / 189registry:outcomes
SURMOUNT-CNA1TIRZ_SC_10MG_QW78arm, responders23 / 54count_from_percentR0007857:Results
SURMOUNT-CNA2TIRZ_SC_15MG_QW78arm, responders26 / 49count_from_percentR0007857:Results
SURMOUNT-CNA3PLACEBO78arm, responders6 / 39count_from_percentR0007857:Results
STEP7A1SEMA_SC_2p4MG_QW44arm, responders151 / 238registry:outcomes
STEP7A2PLACEBO44arm, responders12 / 116registry:outcomes
OASIS 1A1SEMA_PO_50MG_QD68arm, responders220 / 317registry:outcomes
OASIS 1A2PLACEBO68arm, responders35 / 295registry:outcomes
STEP 8A1SEMA_SC_2p4MG_QW68arm, responders83 / 117registry:outcomes
STEP 8A2LIRA_SC_3p0MG_QD68arm, responders30 / 117registry:outcomes
STEP 8A3PLACEBO68arm, responders12 / 78registry:outcomes
STRIVEA1STANDARD_CARE52arm, responders9 / 93R0020855:Table 2
STRIVEA2LIRA_SC_3p0MG_QD52arm, responders90 / 201R0020855:Table 2
STEP 6A1SEMA_SC_1p7MG_QW68arm, responders41 / 98registry:outcomes
STEP 6A2SEMA_SC_2p4MG_QW68arm, responders117 / 193registry:outcomes
STEP 6A3PLACEBO68arm, responders5 / 100registry:outcomes

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