Skip to content

Study · Systematic review · 2026

8 results

Efficacy and safety of European Medicines Agency (EMA)-approved pharmacological, endoscopic, and surgical treatments in different classes of obesity: A network meta-analysis of randomised controlled trials for the development of the SIO (Società Italiana Obesità) Italian guidelines for the diagnosis and treatment of overweight and obesity.

Barazzoni R, Monami M, Buscemi S, Busetto L, De Luca M, Navarra G, Ragghianti B, Silverii GA, Belluzzi A, Mannucci E, Sbraccia P

Diabetes, obesity & metabolism20 Oct 2025Cited by 6 (Europe PMC)

PMID41111360 (opens in a new tab)PMCIDPMC12673438 (opens in a new tab)DOI10.1111/dom.70204 (opens in a new tab)PepBankPUB-41111360
Download PDFPubMedAsk about this study
Jump to 8 results

Summary

AimsWe aimed at comparing different approved strategies (obesity management medications-OMM, endoscopic bariatric procedures-EBP, and metabolic bariatric surgery-MBS) with lifestyle intervention/placebo/no therapy (LSI/Pbo/NT) for the treatment of different BMI-based classes of obesity (i.e., overweight-BMI: 25-29.9 kg/m2; class I-BMI: 30-34.9 kg/m2; class II-BMI: 35-39.9 kg/m2; class III-BMI >39.9 kg/m2).Materials and methodsThis systematic review (SR) and network meta-analysis (NMA) included randomised clinical trials (RCTs) comparing OMM, EBP, and MBS versus either LSI/Pbo/NT or active comparators in individuals with overweight or obesity. A Medline and Embase search was performed up to 31st January 2025 for RCTs on EMA (European Medicines Agency)-approved weight-loss interventions in adults with overweight/obesity. The primary endpoint was total body weight loss (TBWL%), analysed at different time points: 26-52, 53-104, 105-156, and ≥156 weeks. Secondary endpoints included all-cause mortality, quality of life, and serious adverse events (SAE). Weighted mean difference and 95% confidence intervals (WMD, 95% CI) for continuous variables and Mantel-Haenszel odds ratio (MH-OR, 95% CI) for categorical variables were calculated using random effect models. The study was registered on the PROSPERO website (CRD42024625338).ResultsIn trials enroling subjects in class I of obesity, tirzepatide resulted in equal effectiveness to both OAGB and RYGB, and it was significantly superior to all the other comparisons. In trials on class II of obesity, tirzepatide was significantly superior to all the other comparisons and inferior to both OAGB and RYGB. Semaglutide was associated with a higher TBWL% than the other OMMs (with the notable exception of tirzepatide), and it was equally effective to EBP, GCP, and LAGB. In trials enroling patients with a mean BMI >40 kg/m2, the procedure with the highest estimated weight loss was BPD. Semaglutide was statistically less effective than SG and gastric bypass, but not inferior to GCP and LAGB. Both RYGB and OAGB were superior to SG.ConclusionIn patients affected by mild to moderate obesity, newer OMMs (i.e., tirzepatide and semaglutide) appear to be valid alternatives to EBP and MBS. They could be preliminarily chosen as a first-line option based on similar efficacy and greater safety and tolerability. Higher degrees of obesity could be more effectively treated with MBS, the efficacy of which, with the notable exception of LAGB and GCP, appears superior to other treatments, especially in the long term.
CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study8

8 results from studies that gave the peptide. 8 results from people.

  1. 01HumanSystematic reviewEfficacy outcome

    In adults with class I obesity, tirzepatide gave total body weight loss equal to both OAGB and RYGB in a network meta-analysis.

    In plain wordsIn adults with class I obesity, tirzepatide led to weight loss equal to two types of weight-loss surgery (OAGB and RYGB).

    Peptide
    Tirzepatide
    Outcome
    No significant changeTotal body weight loss, class I obesity, versus OAGB and RYGB
    Study

    n: not reported in source

    Comparator
    OAGB and RYGB
    Analysis
    Primary
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    Dose not stated

    Source sentences

    Summary
    In trials enroling subjects in class I of obesity, tirzepatide resulted in equal effectiveness to both OAGB and RYGB, and it was significantly superior to all the other comparisons.
    2 context sentences
    Summary · context
    This systematic review (SR) and network meta-analysis (NMA) included randomised clinical trials (RCTs) comparing OMM, EBP, and MBS versus either LSI/Pbo/NT or active comparators in individuals with overweight or obesity.
    Summary · context
    The primary endpoint was total body weight loss (TBWL%), analysed at different time points: 26-52, 53-104, 105-156, and ≥156 weeks.
  2. 02HumanSystematic reviewEfficacy outcome

    In adults with class I obesity, tirzepatide was significantly superior to all other comparisons except OAGB and RYGB for total body weight loss in a network meta-analysis.

    In plain wordsIn adults with class I obesity, tirzepatide led to more weight loss than the other treatments compared, except two surgeries (OAGB and RYGB).

    Peptide
    Tirzepatide
    Outcome
    IncreaseTotal body weight loss, class I obesity, versus other comparisons
    Study

    n: not reported in source

    Comparator
    All other comparisons
    Analysis
    Primary
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    Dose not stated

    Source sentences

    Summary
    In trials enroling subjects in class I of obesity, tirzepatide resulted in equal effectiveness to both OAGB and RYGB, and it was significantly superior to all the other comparisons.
    2 context sentences
    Summary · context
    This systematic review (SR) and network meta-analysis (NMA) included randomised clinical trials (RCTs) comparing OMM, EBP, and MBS versus either LSI/Pbo/NT or active comparators in individuals with overweight or obesity.
    Summary · context
    The primary endpoint was total body weight loss (TBWL%), analysed at different time points: 26-52, 53-104, 105-156, and ≥156 weeks.
  3. 03HumanSystematic reviewEfficacy outcome

    In adults with class II obesity, tirzepatide was significantly superior to all other comparisons, except OAGB and RYGB, for total body weight loss in a network meta-analysis.

    In plain wordsIn adults with class II obesity, tirzepatide led to more weight loss than the other treatments compared, except two surgeries (OAGB and RYGB).

    Peptide
    Tirzepatide
    Outcome
    IncreaseTotal body weight loss, class II obesity, versus other comparisons
    Study

    n: not reported in source

    Comparator
    All other comparisons
    Analysis
    Primary
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    Dose not stated

    Source sentences

    Summary
    In trials on class II of obesity, tirzepatide was significantly superior to all the other comparisons and inferior to both OAGB and RYGB.
    2 context sentences
    Summary · context
    This systematic review (SR) and network meta-analysis (NMA) included randomised clinical trials (RCTs) comparing OMM, EBP, and MBS versus either LSI/Pbo/NT or active comparators in individuals with overweight or obesity.
    Summary · context
    The primary endpoint was total body weight loss (TBWL%), analysed at different time points: 26-52, 53-104, 105-156, and ≥156 weeks.
  4. 04HumanSystematic reviewEfficacy outcome

    In adults with class II obesity, tirzepatide gave less total body weight loss than both OAGB and RYGB in a network meta-analysis.

    In plain wordsIn adults with class II obesity, tirzepatide led to less weight loss than two types of weight-loss surgery (OAGB and RYGB).

    Peptide
    Tirzepatide
    Outcome
    DecreaseTotal body weight loss, class II obesity, versus OAGB and RYGB
    Study

    n: not reported in source

    Comparator
    OAGB and RYGB
    Analysis
    Primary
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    Dose not stated

    Source sentences

    Summary
    In trials on class II of obesity, tirzepatide was significantly superior to all the other comparisons and inferior to both OAGB and RYGB.
    2 context sentences
    Summary · context
    This systematic review (SR) and network meta-analysis (NMA) included randomised clinical trials (RCTs) comparing OMM, EBP, and MBS versus either LSI/Pbo/NT or active comparators in individuals with overweight or obesity.
    Summary · context
    The primary endpoint was total body weight loss (TBWL%), analysed at different time points: 26-52, 53-104, 105-156, and ≥156 weeks.
  5. 05HumanSystematic reviewEfficacy outcome

    In adults with overweight or obesity, semaglutide was associated with higher total body weight loss than the other obesity medications, except tirzepatide, in a network meta-analysis.

    In plain wordsIn adults with overweight or obesity, semaglutide led to more weight loss than other obesity medicines, except tirzepatide.

    Peptide
    Semaglutide
    Outcome
    IncreaseTotal body weight loss versus other obesity medications
    Study

    n: not reported in source

    Comparator
    Other obesity management medications (tirzepatide excepted)
    Analysis
    Primary
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    Dose not stated

    Source sentences

    Summary
    Semaglutide was associated with a higher TBWL% than the other OMMs (with the notable exception of tirzepatide), and it was equally effective to EBP, GCP, and LAGB.
    2 context sentences
    Summary · context
    This systematic review (SR) and network meta-analysis (NMA) included randomised clinical trials (RCTs) comparing OMM, EBP, and MBS versus either LSI/Pbo/NT or active comparators in individuals with overweight or obesity.
    Summary · context
    The primary endpoint was total body weight loss (TBWL%), analysed at different time points: 26-52, 53-104, 105-156, and ≥156 weeks.
  6. 06HumanSystematic reviewEfficacy outcome

    In adults with overweight or obesity, semaglutide was equally effective as EBP, GCP and LAGB for weight loss in a network meta-analysis.

    In plain wordsIn adults with overweight or obesity, semaglutide led to weight loss equal to endoscopic procedures and two other procedures (GCP, LAGB).

    Peptide
    Semaglutide
    Outcome
    No significant changeTotal body weight loss versus EBP, GCP and LAGB
    Study

    n: not reported in source

    Comparator
    EBP, GCP and LAGB
    Analysis
    Primary
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    Dose not stated

    Source sentences

    Summary
    Semaglutide was associated with a higher TBWL% than the other OMMs (with the notable exception of tirzepatide), and it was equally effective to EBP, GCP, and LAGB.
    2 context sentences
    Summary · context
    This systematic review (SR) and network meta-analysis (NMA) included randomised clinical trials (RCTs) comparing OMM, EBP, and MBS versus either LSI/Pbo/NT or active comparators in individuals with overweight or obesity.
    Summary · context
    The primary endpoint was total body weight loss (TBWL%), analysed at different time points: 26-52, 53-104, 105-156, and ≥156 weeks.
  7. 07HumanSystematic reviewEfficacy outcome

    In trials with a mean BMI above 40 kg/m2, semaglutide was statistically less effective for weight loss than SG and gastric bypass in a network meta-analysis.

    In plain wordsIn people with a BMI above 40, semaglutide led to less weight loss than two types of weight-loss surgery (SG and gastric bypass).

    Peptide
    Semaglutide
    Outcome
    DecreaseTotal body weight loss in BMI above 40 versus SG and gastric bypass
    Study

    n: not reported in source

    Comparator
    SG and gastric bypass
    Analysis
    Primary
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    Dose not stated

    Source sentences

    Summary
    Semaglutide was statistically less effective than SG and gastric bypass, but not inferior to GCP and LAGB.
    3 context sentences
    Summary · context
    In trials enroling patients with a mean BMI >40 kg/m2, the procedure with the highest estimated weight loss was BPD.
    Summary · context
    This systematic review (SR) and network meta-analysis (NMA) included randomised clinical trials (RCTs) comparing OMM, EBP, and MBS versus either LSI/Pbo/NT or active comparators in individuals with overweight or obesity.
    Summary · context
    The primary endpoint was total body weight loss (TBWL%), analysed at different time points: 26-52, 53-104, 105-156, and ≥156 weeks.
  8. 08HumanSystematic reviewEfficacy outcome

    In trials with a mean BMI above 40 kg/m2, semaglutide was not inferior to GCP and LAGB for weight loss in a network meta-analysis.

    In plain wordsIn people with a BMI above 40, semaglutide was not worse than two other weight-loss procedures (GCP, LAGB).

    Peptide
    Semaglutide
    Outcome
    No significant changeTotal body weight loss in BMI above 40 versus GCP and LAGB
    Study

    n: not reported in source

    Comparator
    GCP and LAGB
    Analysis
    Primary
    Outcome group
    Body weight · Metabolic and weight
    Studied dose
    Dose not stated

    Source sentences

    Summary
    Semaglutide was statistically less effective than SG and gastric bypass, but not inferior to GCP and LAGB.
    3 context sentences
    Summary · context
    In trials enroling patients with a mean BMI >40 kg/m2, the procedure with the highest estimated weight loss was BPD.
    Summary · context
    This systematic review (SR) and network meta-analysis (NMA) included randomised clinical trials (RCTs) comparing OMM, EBP, and MBS versus either LSI/Pbo/NT or active comparators in individuals with overweight or obesity.
    Summary · context
    The primary endpoint was total body weight loss (TBWL%), analysed at different time points: 26-52, 53-104, 105-156, and ≥156 weeks.

AI wrote and checked these results. AI can make mistakes, so check important results against the source.

Version history

PepBank keeps every version of the data on this study. Status changes from Retraction Watch, Europe PMC and Crossref are listed with their source.

  1. Version 3Current

    11 Oct 2026, 00:04 UTC

    Study results updated

  2. Version 2

    9 Oct 2026, 03:07 UTC

    Study data updated · source update from Europe PMC

  3. Version 1

    9 Oct 2026, 03:06 UTC

    First added · source update from Europe PMC

Subjects

Terms as the source lists them.

PepBank is a research reference. Talk to a doctor before you use any peptide.