Network meta-analysis

BMI standard deviation score change

Children and adolescents with obesity

weeks 40 to 104 (target week 68)Treatment policyDoses of a drug pooledMean difference

Randomized trials

Treatments

411

Participants

Trial arms

In plain language

Across 2 trials with 411 participants, 1 of 2 treatments had a clearly better result than placebo on BMI standard deviation score change, and for 1 the evidence could not tell it apart from placebo. The most favorable estimate was for Semaglutide injection: mean difference -0.96 SDS units (95% credible interval -1.27 to -0.54).

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

Each circle is a treatment; each line joins treatments that were randomized against each other in at least one trial.

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

Mean difference in SDS units. Lower values favor the treatment.

Versus Placebo. 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
Treatment	Bayesian MD (95% CrI)	95% prediction interval	Frequentist MD (95% CI)	Verdict
Semaglutide injection SEMA_SC	-0.96 (-1.27 to -0.54)	-1.37 to -0.42	-1.00 (-1.20 to -0.80)	Better
Liraglutide injection LIRA_SC	-0.23 (-0.55 to 0.12)	-0.68 to 0.26	-0.23 (-0.37 to -0.09)	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: mean difference 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 column	PLACEBO	SEMA_SC	LIRA_SC
PLACEBO	PLACEBO	0.96 0.54 to 1.27	0.23 -0.12 to 0.55
SEMA_SC	-0.96 -1.27 to -0.54	SEMA_SC	-0.73 -1.18 to -0.17
LIRA_SC	-0.23 -0.55 to 0.12	0.73 0.17 to 1.18	LIRA_SC

Heterogeneity, fit and convergence

Bayesian random effects (primary)

Heterogeneity (tau): 0.104 (95% CrI 0.004 to 0.332)
Residual deviance: 4.0 for 4 data points
DIC: 7.9 (pD 3.9)
Largest R-hat: 1.002
Smallest ESS: bulk 3,038, tail 2,667
Divergent transitions: 0
Convergence: All criteria met
Priors: PR01 N(0, 1.5^2); PR03 N(0, 0.75^2); PR07 half normal(0, 0.15^2) on tau

Frequentist check (netmeta)

Method: inverse variance, REML, MD
Tau: 0.000
Q (total): 0.00 on 0 df
Q (between designs): 0.00

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.

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.

NoteOutcome assessment, time point: selected time points span 56 to 68 weeks

Comparability items per trial
Trial	time weeks	analysis set	definition	instrument	adjudicated	proportion method	intercurrent events (discontinuation)	intercurrent events (rescue)	blinding	funding	start year	Eligibility
NCT02918279	56	full_analysis	not stated	not stated	not stated	not stated	not stated	not stated	double_blind	industry	2016	pubertal age 12 to under 18; BMI equivalent to adult 30 or more; poor response to lifestyle therapy
NCT04102189	68	full_analysis	not stated	not stated	not stated	not stated	not stated	not stated	double_blind	industry	2019	age 12 to under 18; BMI 95th percentile or more, or 85th with a comorbidity

Trial data

What each trial contributes. Arm rows give the arm value with its standard error, or events over participants; contrast rows give the mean difference on the analysis scale against the trial's first row. Flags mark converted, combined or approximated inputs.

Trial data entering this analysis
Trial	Arm	Treatment	Week	Data	Value	SE	Events / N	Source
NCT02918279	A1	LIRA_SC	56	arm, change	-0.250	0.048	113	registry:outcomes
NCT02918279	A2	PLACEBO	56	arm, change	-0.020	0.053	105	registry:outcomes
NCT04102189	A1	SEMA_SC	68	arm, change	-1.100	0.079	131	registry:outcomes
NCT04102189	A2	PLACEBO	68	arm, change	-0.100	0.064	62	registry:outcomes

Rerun this analysis yourself

Remove treatments or trials and refit the frequentist and Bayesian models in your browser, with the same methods as the published analysis.

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