Weight loss of 10 percent or more
Overweight or obesity without diabetes (adults)
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
Effects compared with Placebo
| Treatment | Bayesian OR (95% CrI) | 95% prediction interval | Frequentist 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 463 | 122 (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 249 | 73.21 (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 75.78 | 25.97 (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 50.97 | 18.17 (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 60.55 | 16.85 (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 36.75 | 12.79 (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 34.79 | 9.77 (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 27.68 | 6.22 (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 16.09 | 5.68 (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 18.09 | 4.08 (1.02 to 16.37) | Unclear |
| Bimagrumab OTHER_ACTIVE_bimagrumab | 2.77 (0.90 to 7.87) | 0.63 to 11.24 | 4.16 (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 8.49 | 2.26 (0.82 to 6.22) | Unclear |
| Standard care or no added treatment STANDARD_CARE | 0.29 (0.07 to 1.31) | 0.05 to 1.74 | 0.30 (0.06 to 1.43) | Unclear |
Ranking
League table
| Row versus column | PLACEBO | BIMASEMA_SC_2p4-30MG_QW | BIMASEMA_SC_2p4-10MG_QW | BIMASEMA_SC_1p0-30MG_QW | SEMA_SC_2p4MG_QW | SEMA_PO_50MG_QD | BIMASEMA_SC_1p0-10MG_QW | SEMA_SC_1p7MG_QW | TIRZ_SC_15MG_QW | SEMA_SC_1p0MG_QW | TIRZ_SC_10MG_QW | OTHER_ACTIVE_bimagrumab | LIRA_SC_3p0MG_QD | STANDARD_CARE |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PLACEBO | PLACEBO | 0.02 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_QW | 65.67 14.59 to 356 | BIMASEMA_SC_2p4-30MG_QW | 1.52 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_QW | 43.43 10.55 to 197 | 0.66 0.09 to 4.55 | BIMASEMA_SC_2p4-10MG_QW | 2.63 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_QW | 16.73 4.66 to 55.03 | 0.25 0.04 to 1.29 | 0.38 0.07 to 1.83 | BIMASEMA_SC_1p0-30MG_QW | 1.01 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_QW | 16.62 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_QW | 1.06 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_QD | 15.53 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_QD | 1.87 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_QW | 8.35 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_QW | 1.01 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_QW | 8.29 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_QW | 1.53 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_QW | 5.36 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_QW | 1.40 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_QW | 3.80 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_QW | 1.06 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_QW | 3.54 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_QW | 1.28 0.24 to 7.14 | 1.64 0.31 to 8.72 | 12.25 1.69 to 84.13 |
| OTHER_ACTIVE_bimagrumab | 2.77 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_bimagrumab | 1.30 0.29 to 5.17 | 9.48 1.44 to 57.53 |
| LIRA_SC_3p0MG_QD | 2.16 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_QD | 7.38 2.21 to 23.97 |
| STANDARD_CARE | 0.29 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)
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; 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 | 38.55 | 0 population codes | 77.6 | 104 | standard |
| BARI-STEP S000434 | 41.5 | 10 | 82.85 | 68 | standard |
| NCT05616013 S000715 | 37.3 | 0 population codes | 57.37 | 48 | standard |
| STEP 10 S000832 | 39.9 | 0 population codes | 71.01 | 52 | not_reported |
| STEP 3 S000988 | 38 | 0 population codes | 81.01 | 68 | intensive |
| SURMOUNT-CN S001086 | body weight 91.8 kg | 0 population codes | 49.05 | 52 | standard |
| STEP7 S001288 | not reported | 0 population codes | 45.33 | 44 | standard |
| OASIS 1 S001472 | not reported | 0 population codes | 72.71 | 68 | not_reported |
| STEP 8 S001600 | not reported | 0 population codes | 78.4 | 68 | standard |
| STRIVE S001687 | 45.96 | 35.5 | 64.28 | 104 | intensive |
| STEP 6 S002102 | not reported | 0 population codes | 36.91 | 68 | not_reported |
Comparability of the trials
- 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
| Trial | time weeks | analysis set | definition | instrument | adjudicated | proportion method | intercurrent events (discontinuation) | intercurrent events (rescue) | blinding | funding | start year | Eligibility |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEP 5 | 52 | full_analysis | not stated | not stated | not stated | not stated | not stated | not stated | double_blind | industry | 2018 | age 18 or older; BMI 30 or more, or 27 or more with comorbidity; no diabetes; HbA1c below 6.5 percent |
| BARI-STEP | 68 | modified_itt | 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 |
| NCT05616013 | 48 | completers | not stated | not stated | not stated | observed | not stated | not stated | open_label | industry | 2022 | adults 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 10 | 52 | full_analysis | not stated | not stated | not stated | not stated | not stated | not stated | double_blind | industry | 2021 | Adults with obesity and prediabetes; diabetes excluded |
| STEP 3 | 68 | full_analysis | not stated | not stated | not stated | not stated | not stated | not stated | double_blind | industry | 2018 | BMI 30 or more, or 27 with comorbidity; no type 2 diabetes |
| SURMOUNT-CN | 78 | completers | not stated | not stated | not stated | observed | not stated | not stated | double_blind | industry | 2021 | Chinese adults; BMI 28 or more, or 24 or more with a weight related comorbidity; no diabetes |
| STEP7 | 44 | full_analysis | not stated | not stated | not stated | not stated | not stated | not stated | double_blind | industry | 2020 | age 18 or older; BMI 30 or more, or 27 or more with a weight related comorbidity including T2D |
| OASIS 1 | 68 | full_analysis | not stated | not stated | not stated | not stated | not stated | not stated | double_blind | industry | 2021 | overweight or obesity |
| STEP 8 | 68 | full_analysis | not stated | not stated | not stated | not stated | not stated | not stated | double_blind | industry | 2019 | age 18 or older; BMI 30 or higher, or 27 with a weight related comorbidity; no type 2 diabetes |
| STRIVE | 52 | completers | not stated | not stated | not stated | not stated | not stated | not stated | open_label | industry | 2017 | age 18 to 75; BMI 35 or more plus prediabetes, T2D, hypertension or sleep apnea; no insulin or GLP-1 RA |
| STEP 6 | 68 | full_analysis | not stated | not stated | not stated | not stated | not stated | not stated | double_blind | industry | 2019 |
Trial data
| Trial | Arm | Treatment | Week | Data | Value | SE | Events / N | Flags | Source |
|---|---|---|---|---|---|---|---|---|---|
| STEP 5 | A1 | SEMA_SC_2p4MG_QW | 52 | arm, responders | 102 / 149 | registry:outcomes | |||
| STEP 5 | A2 | PLACEBO | 52 | arm, responders | 17 / 129 | registry:outcomes | |||
| BARI-STEP | A1 | PLACEBO | 68 | arm, responders | 2 / 29 | R0014003:Results | |||
| BARI-STEP | A2 | SEMA_SC_2p4MG_QW | 68 | arm, responders | 29 / 34 | R0014003:Results | |||
| NCT05616013 | A1 | PLACEBO | 48 | arm, responders | 3 / 35 | count_from_percent | registry:outcomes | ||
| NCT05616013 | A2+A3 | OTHER_ACTIVE_bimagrumab | 48 | arm, responders | 28 / 68 | count_from_percent;arms_combined | registry:outcomes | ||
| NCT05616013 | A4 | SEMA_SC_1p0MG_QW | 48 | arm, responders | 22 / 45 | count_from_percent | registry:outcomes | ||
| NCT05616013 | A5 | SEMA_SC_2p4MG_QW | 48 | arm, responders | 41 / 51 | count_from_percent | registry:outcomes | ||
| NCT05616013 | A6 | BIMASEMA_SC_1p0-10MG_QW | 48 | arm, responders | 28 / 41 | count_from_percent | registry:outcomes | ||
| NCT05616013 | A7 | BIMASEMA_SC_2p4-10MG_QW | 48 | arm, responders | 37 / 40 | count_from_percent | registry:outcomes | ||
| NCT05616013 | A8 | BIMASEMA_SC_1p0-30MG_QW | 48 | arm, responders | 35 / 43 | count_from_percent | registry:outcomes | ||
| NCT05616013 | A9 | BIMASEMA_SC_2p4-30MG_QW | 48 | arm, responders | 41 / 43 | count_from_percent | registry:outcomes | ||
| STEP 10 | A1 | SEMA_SC_2p4MG_QW | 52 | arm, responders | 95 / 129 | registry:outcomes | |||
| STEP 10 | A2 | PLACEBO | 52 | arm, responders | 5 / 66 | registry:outcomes | |||
| STEP 3 | A1 | SEMA_SC_2p4MG_QW | 68 | arm, responders | 281 / 373 | registry:outcomes | |||
| STEP 3 | A2 | PLACEBO | 68 | arm, responders | 51 / 189 | registry:outcomes | |||
| SURMOUNT-CN | A1 | TIRZ_SC_10MG_QW | 78 | arm, responders | 23 / 54 | count_from_percent | R0007857:Results | ||
| SURMOUNT-CN | A2 | TIRZ_SC_15MG_QW | 78 | arm, responders | 26 / 49 | count_from_percent | R0007857:Results | ||
| SURMOUNT-CN | A3 | PLACEBO | 78 | arm, responders | 6 / 39 | count_from_percent | R0007857:Results | ||
| STEP7 | A1 | SEMA_SC_2p4MG_QW | 44 | arm, responders | 151 / 238 | registry:outcomes | |||
| STEP7 | A2 | PLACEBO | 44 | arm, responders | 12 / 116 | registry:outcomes | |||
| OASIS 1 | A1 | SEMA_PO_50MG_QD | 68 | arm, responders | 220 / 317 | registry:outcomes | |||
| OASIS 1 | A2 | PLACEBO | 68 | arm, responders | 35 / 295 | registry:outcomes | |||
| STEP 8 | A1 | SEMA_SC_2p4MG_QW | 68 | arm, responders | 83 / 117 | registry:outcomes | |||
| STEP 8 | A2 | LIRA_SC_3p0MG_QD | 68 | arm, responders | 30 / 117 | registry:outcomes | |||
| STEP 8 | A3 | PLACEBO | 68 | arm, responders | 12 / 78 | registry:outcomes | |||
| STRIVE | A1 | STANDARD_CARE | 52 | arm, responders | 9 / 93 | R0020855:Table 2 | |||
| STRIVE | A2 | LIRA_SC_3p0MG_QD | 52 | arm, responders | 90 / 201 | R0020855:Table 2 | |||
| STEP 6 | A1 | SEMA_SC_1p7MG_QW | 68 | arm, responders | 41 / 98 | registry:outcomes | |||
| STEP 6 | A2 | SEMA_SC_2p4MG_QW | 68 | arm, responders | 117 / 193 | registry:outcomes | |||
| STEP 6 | A3 | PLACEBO | 68 | arm, responders | 5 / 100 | registry:outcomes |
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