Pairwise meta-analysis

Constipation

Polycystic ovary syndrome

longest follow-upRecorded harmsDoses of a drug pooledHazard ratio (from event counts)Convergence criteria not all met

Randomized trials

Treatments

226

Participants

Events

In plain language

Across 3 trials with 226 participants, 0 of 1 treatment had a clearly better result than placebo on constipation, 1 a clearly worse one. The most favorable estimate was for Liraglutide injection: hazard ratio (from event counts) 9.40 (95% credible interval 2.05 to 59.00).

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

Hazard ratio (from event counts). Lower values favor the treatment.

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
Treatment	Bayesian HR (95% CrI)	95% prediction interval	Frequentist HR (95% CI)	Verdict
Liraglutide injection LIRA_SC	9.40 (2.05 to 59.00)	1.22 to 93.04		Worse

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.

Heterogeneity, fit and convergence

Bayesian random effects (primary)

Heterogeneity (tau): 0.423 (95% CrI 0.091 to 1.739), log scale
Residual deviance: 7.8 for 6 data points
DIC: 11.6 (pD 3.9)
Largest R-hat: 1.002
Smallest ESS: bulk 2,574, tail 2,558
Divergent transitions: 1
Convergence: Not all met; read with caution
Priors: PR02 N(0, 5^2); PR05 N(0, 2.5^2); PR09 log normal(-1.87, 1.52^2) on tau^2 (Adverse events, pharm vs placebo control)

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.

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 26 to 36 weeks
NoteOutcome assessment, analysis set: mixed: other 1, safety 2
NoteRisk of bias, funding: mixed: industry 1, mixed 2
NoteData handling, input conversions: nonserious_only 2

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
SAXAPCOS	36	safety	not stated	not stated	not stated	not stated	not stated	not stated	double_blind	industry	2018	premenopausal women 18 to 45 years; PCOS by modified NIH 1990; BMI 30 or more; no diabetes
LIPT	26	safety	not stated	not stated	not stated	not stated	not stated	not stated	double_blind	mixed	2014	Rotterdam PCOS; BMI over 25 or insulin resistance; non hormonal contraception; no diabetes or CVD
S003101	26	other	not stated	not stated	not stated	not stated	not stated	not stated	double_blind	mixed	2014	premenopausal women 18 or older; Rotterdam PCOS; BMI 25 or more and/or C-peptide above 0.6 nmol/L; no diabetes

Trial data

What each trial contributes. Arm rows give the arm value with its standard error, or events over participants; contrast rows give the hazard ratio (from event counts) on the analysis scale (log) against the trial's first row. Flags mark converted, combined or approximated inputs.

Trial data entering this analysis
Trial	Arm	Treatment	Week	Data	Events / N	Flags	Source
SAXAPCOS	A1	LIRA_SC	36	arm, events	3 / 55		R0022023:Table 4
SAXAPCOS	A2	PLACEBO	36	arm, events	1 / 27		R0022023:Table 4
LIPT	A1	LIRA_SC	26	arm, events	12 / 48	nonserious_only	registry:adverse_events
LIPT	A2	PLACEBO	26	arm, events	0 / 24	nonserious_only	registry:adverse_events
S003101	A1	LIRA_SC	26	arm, events	12 / 48		R0025661:Table 2
S003101	A2	PLACEBO	26	arm, events	0 / 24		R0025661:Table 2

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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