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   "text": "Table 1: Submitted for Review ; Table 2: Sample table for presenting the estimated prevalence in each region; Table 3: Key characteristics of Drug 1, Drug 2, etc.; Table 4: Proposed Reimbursement Conditions for the Drug Under Review; Table 5: Inclusion criteria for the systematic review; Table 6: Details of Included Studies; Table 7: Summary of Outcomes Relevant to the Systematic Review ; Table 8: Statistical Analysis of Efficacy Endpoints; Table 9: Analysis Populations of Study 1 and Study 2; Table 10: Summary of Baseline Characteristics of Study 1 and Study 2; Table 11: Sample Table for Pati"
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   "alias": "Estimated prevalence \u2014 Alberta \u2014 upper estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
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   "text": "Not reported. (CSR p. 31: background.)",
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   "alias": "Estimated prevalence \u2014 British Columbia \u2014 lower estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
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   "text": "Not reported. (CSR p. 31: background.)",
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   "alias": "Estimated prevalence \u2014 British Columbia \u2014 best estimate",
   "group": "Estimated prevalence",
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   "text": "Not reported. (CSR p. 31: background.)",
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   "alias": "Estimated prevalence \u2014 British Columbia \u2014 upper estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
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   "alias": "Estimated prevalence \u2014 Manitoba \u2014 lower estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
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   "text": "Not reported. (CSR p. 31: background.)",
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   "alias": "Estimated prevalence \u2014 Manitoba \u2014 best estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
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   "text": "Not reported. (CSR p. 31: background.)",
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   "alias": "Estimated prevalence \u2014 Manitoba \u2014 upper estimate",
   "group": "Estimated prevalence",
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   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 3
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   "alias": "Estimated prevalence \u2014 New Brunswick \u2014 lower estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 5
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  {
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   "alias": "Estimated prevalence \u2014 New Brunswick \u2014 best estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 2
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  {
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   "alias": "Estimated prevalence \u2014 New Brunswick \u2014 upper estimate",
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   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 3
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   "alias": "Estimated prevalence \u2014 Newfoundland and Labrador \u2014 lower estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 5
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  {
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   "alias": "Estimated prevalence \u2014 Newfoundland and Labrador \u2014 best estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 2
  },
  {
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   "alias": "Estimated prevalence \u2014 Newfoundland and Labrador \u2014 upper estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
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  {
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   "alias": "Estimated prevalence \u2014 Northwest Territories \u2014 lower estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 5
  },
  {
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   "alias": "Estimated prevalence \u2014 Northwest Territories \u2014 best estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 2
  },
  {
   "id": "1233515049",
   "alias": "Estimated prevalence \u2014 Northwest Territories \u2014 upper estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 3
  },
  {
   "id": "1926722373",
   "alias": "Estimated prevalence \u2014 Nova Scotia \u2014 lower estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 5
  },
  {
   "id": "865436102",
   "alias": "Estimated prevalence \u2014 Nova Scotia \u2014 best estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 2
  },
  {
   "id": "1028952913",
   "alias": "Estimated prevalence \u2014 Nova Scotia \u2014 upper estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 3
  },
  {
   "id": "1164403495",
   "alias": "Estimated prevalence \u2014 Nunavut \u2014 lower estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 5
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  {
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   "alias": "Estimated prevalence \u2014 Nunavut \u2014 best estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
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  },
  {
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   "alias": "Estimated prevalence \u2014 Nunavut \u2014 upper estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
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  {
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   "alias": "Estimated prevalence \u2014 Ontario \u2014 lower estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
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  {
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   "alias": "Estimated prevalence \u2014 Ontario \u2014 best estimate",
   "group": "Estimated prevalence",
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   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
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  {
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   "alias": "Estimated prevalence \u2014 Ontario \u2014 upper estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 3
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  {
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   "alias": "Estimated prevalence \u2014 Prince Edward Island \u2014 lower estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 5
  },
  {
   "id": "503914152",
   "alias": "Estimated prevalence \u2014 Prince Edward Island \u2014 best estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 2
  },
  {
   "id": "244229309",
   "alias": "Estimated prevalence \u2014 Prince Edward Island \u2014 upper estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 3
  },
  {
   "id": "50866461",
   "alias": "Estimated prevalence \u2014 Saskatchewan \u2014 lower estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 5
  },
  {
   "id": "1870012319",
   "alias": "Estimated prevalence \u2014 Saskatchewan \u2014 best estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 2
  },
  {
   "id": "1477188374",
   "alias": "Estimated prevalence \u2014 Saskatchewan \u2014 upper estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 3
  },
  {
   "id": "1187982909",
   "alias": "Estimated prevalence \u2014 Yukon \u2014 lower estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 5
  },
  {
   "id": "1237249317",
   "alias": "Estimated prevalence \u2014 Yukon \u2014 best estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 2
  },
  {
   "id": "1079986308",
   "alias": "Estimated prevalence \u2014 Yukon \u2014 upper estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
   "csr_pages_with_field_terms": 3
  },
  {
   "id": "106495390",
   "alias": "Estimated prevalence \u2014 Non-Insured Health Benefits \u2014 lower estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
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  },
  {
   "id": "1128413559",
   "alias": "Estimated prevalence \u2014 Non-Insured Health Benefits \u2014 best estimate",
   "group": "Estimated prevalence",
   "state": "not_in_csr",
   "chars": 38,
   "text": "Not reported. (CSR p. 31: background.)",
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  {
   "id": "1512039669",
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   "text": "Not reported. (CSR p. 31: background.)",
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   "id": "1333223319",
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   "text": "Trial assessment included body weight, height/BMI, waist circumference and laboratory measures including HbA1c and fasting plasma glucose; HbA1c \u22656.5% was a key exclusion. Requirements for routine Canadian diagnostic testing are not reported. (CSR pp. 37, 45-46.)",
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   "alias": "Diagnosis \u2014 availability of diagnostic testing",
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   "text": "Central and specialized laboratories were used in the trial; availability, access barriers and coverage of diagnostic testing in Canadian practice are not reported. (CSR p. 29.)",
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   "id": "193925407",
   "alias": "Health Care Resources - Pre-treatment phase",
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   "text": "Trial screening assessed eligibility and included a food diary and mental-health randomization criteria. Canadian pre-treatment resource use and costs are not reported. (CSR pp. 37-38.)",
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  {
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   "alias": "Health care resources \u2014 treatment phase",
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   "text": "Both groups received counselling every 4 weeks for a 500 kcal/day deficit and \u2265150 minutes/week of physical activity, with daily food/activity records. (CSR p. 41.) Trial use of injections and safety assessments is described, but routine-care resource quantities and costs are not reported. (CSR pp. ",
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   "id": "1278843648",
   "alias": "Health Care Resources - Post-treatment phase",
   "group": "Health Care Resources",
   "state": "not_in_csr",
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   "text": "A safety follow-up visit was scheduled 7 weeks after treatment; routine Canadian post-treatment resource use and costs are not reported. (CSR pp. 35-36.)",
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  {
   "id": "1769136716",
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   "text": "The CSR describes lifestyle intervention (diet and exercise) as first-line treatment, bariatric surgery as an option for some people with severe obesity, and pharmacotherapy as a potential alternative. It does not set out a Canadian reimbursement algorithm. (CSR pp. 31, 36.)"
  },
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   "text": "The CSR identifies difficulty sustaining weight loss, biological responses promoting regain, limitations of surgery and a need for safe, effective, convenient therapies supporting weight maintenance and comorbidity management. (CSR p. 31.)"
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   "id": "703979793",
   "alias": "Place in therapy \u2014 proposed place in therapy",
   "group": "Place in therapy",
   "state": "not_in_csr",
   "chars": 300,
   "text": "Adults aged \u226518 years with BMI \u226530 kg/m\u00b2, or \u226527 kg/m\u00b2 with hypertension, dyslipidaemia, obstructive sleep apnoea or cardiovascular disease, and \u22651 unsuccessful dietary weight-loss effort; type 2 diabetes excluded. (CSR pp. 36-37.) Canadian reimbursement positioning is not reported. (CSR pp. 32-37.)",
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  {
   "id": "678809355",
   "alias": "Place in therapy \u2014 impact on currently reimbursed treatments",
   "group": "Place in therapy",
   "state": "not_in_csr",
   "chars": 149,
   "text": "Effects on utilization, displacement or funding of currently reimbursed treatments are not reported. (CSR pp. 31-37: trial rationale and comparator.)",
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   "alias": "Provisional algorithm diagram - description",
   "group": "Provisional algorithm diagram",
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   "text": "Not applicable to this weight-management trial; an oncology treatment algorithm is not reported. (CSR pp. 2, 32-37.)",
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   "id": "518136981",
   "alias": "Place in therapy \u2014 provisional algorithm figure",
   "group": "Place in therapy",
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   "text": "Not applicable to this weight-management trial; an oncology treatment algorithm is not reported. (CSR pp. 2, 32-37.)",
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   "text": "The randomized comparator was matching subcutaneous placebo plus the same lifestyle intervention. No active-comparator randomized arm is reported. (CSR pp. 37, 39-41.)"
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   "id": "284852098",
   "alias": "Comparators \u2014 drug under review name",
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   "text": "Semaglutide. (CSR p. 40.)"
  },
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   "id": "1583495440",
   "alias": "Comparators \u2014 drug under review indication",
   "group": "Comparators",
   "state": "not_in_csr",
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   "text": "Trial: weight management; Canadian indication not reported. (CSR pp. 2, 37.)",
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   "alias": "Comparators \u2014 drug under review regimen",
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   "text": "Trial regimen: semaglutide subcutaneously once weekly, 0.25, 0.5, 1.0 and 1.7 mg for 4 weeks each, then 2.4 mg for 52 weeks. A 1.7 mg maintenance dose was permitted for intolerance, with an attempt to re-escalate recommended. (CSR pp. 39-40, Tables 9-1 and 9-2.)"
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   "alias": "Comparators \u2014 comparator 1 name",
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   "text": "Matching placebo. (CSR p. 40.)"
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   "id": "351979935",
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   "text": "Control intervention in STEP 1. (CSR p. 37.)"
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  {
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   "text": "Subcutaneous once weekly; volume matched to semaglutide escalation and maintenance; same lifestyle counselling. (CSR pp. 39-41.)"
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  {
   "id": "2138645005",
   "alias": "Comparators \u2014 comparator 1 indirect comparison rationale",
   "group": "Comparators",
   "state": "not_in_csr",
   "chars": 120,
   "text": "Not reported in the supplied CSR: no indirect comparison is presented. (CSR pp. 32-37: direct placebo-controlled trial.)",
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  },
  {
   "id": "1584295274",
   "alias": "Comparators \u2014 comparator 1 pharmacoeconomic evaluation rationale",
   "group": "Comparators",
   "state": "not_in_csr",
   "chars": 120,
   "text": "Not reported in the supplied CSR: no pharmacoeconomic submission is presented. (CSR pp. 1, 32-36: clinical-trial scope.)",
   "csr_pages_with_field_terms": 1
  },
  {
   "id": "56679918",
   "alias": "Comparators \u2014 comparator 2 name",
   "group": "Comparators",
   "state": "not_in_csr",
   "chars": 71,
   "text": "Not reported in the supplied CSR. (CSR pp. 1, 32, 35-36: report scope.)",
   "csr_pages_with_field_terms": 0
  },
  {
   "id": "1139272176",
   "alias": "Comparators \u2014 comparator 2 indication",
   "group": "Comparators",
   "state": "not_in_csr",
   "chars": 71,
   "text": "Not reported in the supplied CSR. (CSR pp. 1, 32, 35-36: report scope.)",
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  },
  {
   "id": "1671645521",
   "alias": "Comparators \u2014 comparator 2 regimen",
   "group": "Comparators",
   "state": "not_in_csr",
   "chars": 71,
   "text": "Not reported in the supplied CSR. (CSR pp. 1, 32, 35-36: report scope.)",
   "csr_pages_with_field_terms": 0
  },
  {
   "id": "1471605575",
   "alias": "Comparators \u2014 comparator 2 indirect comparison rationale",
   "group": "Comparators",
   "state": "not_in_csr",
   "chars": 120,
   "text": "Not reported in the supplied CSR: no indirect comparison is presented. (CSR pp. 32-37: direct placebo-controlled trial.)",
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  },
  {
   "id": "1117325907",
   "alias": "Comparators \u2014 comparator 2 pharmacoeconomic evaluation rationale",
   "group": "Comparators",
   "state": "not_in_csr",
   "chars": 120,
   "text": "Not reported in the supplied CSR: no pharmacoeconomic submission is presented. (CSR pp. 1, 32-36: clinical-trial scope.)",
   "csr_pages_with_field_terms": 1
  },
  {
   "id": "451938502",
   "alias": "Comparators \u2014 data sources",
   "group": "Comparators",
   "state": "answered",
   "chars": 151,
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   "numbers": {},
   "bracket_cites": 0,
   "text": "Source for completed entries: reference 1, STEP 1 CSR; specific page/table citations appear in each completed field. No other evidence source was used."
  },
  {
   "id": "691662644",
   "alias": "Proposed reimbursement conditions",
   "group": "Proposed reimbursement conditions",
   "state": "not_in_csr",
   "chars": 213,
   "text": "Proposed initiation, renewal, discontinuation and prescribing reimbursement conditions and their rationales are not reported; trial eligibility and stopping rules are not reimbursement conditions. (CSR pp. 37-39.)",
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  },
  {
   "id": "115541822",
   "alias": "Reimbursement conditions \u2014 initiation condition",
   "group": "Reimbursement conditions",
   "state": "not_in_csr",
   "chars": 93,
   "text": "Not reported in CSR: reimbursement condition/rationale. (CSR pp. 37-39: trial criteria only.)",
   "csr_pages_with_field_terms": 1
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  {
   "id": "1440032977",
   "alias": "Reimbursement conditions \u2014 initiation rationale",
   "group": "Reimbursement conditions",
   "state": "not_in_csr",
   "chars": 93,
   "text": "Not reported in CSR: reimbursement condition/rationale. (CSR pp. 37-39: trial criteria only.)",
   "csr_pages_with_field_terms": 0
  },
  {
   "id": "1774983937",
   "alias": "Reimbursement conditions \u2014 initiation alignment condition",
   "group": "Reimbursement conditions",
   "state": "not_in_csr",
   "chars": 93,
   "text": "Not reported in CSR: reimbursement condition/rationale. (CSR pp. 37-39: trial criteria only.)",
   "csr_pages_with_field_terms": 1
  },
  {
   "id": "1288836516",
   "alias": "Reimbursement conditions \u2014 initiation alignment rationale",
   "group": "Reimbursement conditions",
   "state": "not_in_csr",
   "chars": 93,
   "text": "Not reported in CSR: reimbursement condition/rationale. (CSR pp. 37-39: trial criteria only.)",
   "csr_pages_with_field_terms": 0
  },
  {
   "id": "198562177",
   "alias": "Reimbursement conditions \u2014 renewal condition",
   "group": "Reimbursement conditions",
   "state": "not_in_csr",
   "chars": 93,
   "text": "Not reported in CSR: reimbursement condition/rationale. (CSR pp. 37-39: trial criteria only.)",
   "csr_pages_with_field_terms": 1
  },
  {
   "id": "1469981911",
   "alias": "Reimbursement conditions \u2014 renewal rationale",
   "group": "Reimbursement conditions",
   "state": "not_in_csr",
   "chars": 93,
   "text": "Not reported in CSR: reimbursement condition/rationale. (CSR pp. 37-39: trial criteria only.)",
   "csr_pages_with_field_terms": 0
  },
  {
   "id": "593079894",
   "alias": "Reimbursement conditions \u2014 renewal alignment condition",
   "group": "Reimbursement conditions",
   "state": "not_in_csr",
   "chars": 93,
   "text": "Not reported in CSR: reimbursement condition/rationale. (CSR pp. 37-39: trial criteria only.)",
   "csr_pages_with_field_terms": 1
  },
  {
   "id": "181289987",
   "alias": "Reimbursement conditions \u2014 renewal alignment rationale",
   "group": "Reimbursement conditions",
   "state": "not_in_csr",
   "chars": 93,
   "text": "Not reported in CSR: reimbursement condition/rationale. (CSR pp. 37-39: trial criteria only.)",
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  },
  {
   "id": "806644934",
   "alias": "Reimbursement conditions \u2014 discontinuation condition",
   "group": "Reimbursement conditions",
   "state": "not_in_csr",
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   "text": "Not reported in CSR: reimbursement condition/rationale. (CSR pp. 37-39: trial criteria only.)",
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   "alias": "Reimbursement conditions \u2014 discontinuation rationale",
   "group": "Reimbursement conditions",
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   "text": "Not reported in CSR: reimbursement condition/rationale. (CSR pp. 37-39: trial criteria only.)",
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  {
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   "alias": "Reimbursement conditions \u2014 prescribing condition",
   "group": "Reimbursement conditions",
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   "text": "Not reported in CSR: reimbursement condition/rationale. (CSR pp. 37-39: trial criteria only.)",
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   "alias": "Reimbursement conditions \u2014 prescribing rationale",
   "group": "Reimbursement conditions",
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   "chars": 93,
   "text": "Not reported in CSR: reimbursement condition/rationale. (CSR pp. 37-39: trial criteria only.)",
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   "text": "AE = adverse event; CI = confidence interval; FAS = full analysis set; OR = odds ratio; SAE = serious adverse event. (CSR pp. 25-26, 58.)"
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  {
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   "text": "No systematic review is reported in the CSR. The available clinical evidence summarized here is STEP 1, whose primary objective was comparison of weight change with semaglutide versus placebo, both with lifestyle intervention. (CSR pp. 1, 32-33.)"
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  {
   "id": "1711002088",
   "alias": "Review protocol PICO - Population",
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   "text": "Adults aged \u226518 years with BMI \u226530 kg/m\u00b2, or \u226527 kg/m\u00b2 with hypertension, dyslipidaemia, obstructive sleep apnoea or cardiovascular disease, and \u22651 unsuccessful dietary weight-loss effort; type 2 diabetes excluded. (CSR pp. 36-37.) Systematic-review population criteria and subgroups are not reported",
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   "text": "Trial regimen: semaglutide subcutaneously once weekly, 0.25, 0.5, 1.0 and 1.7 mg for 4 weeks each, then 2.4 mg for 52 weeks. A 1.7 mg maintenance dose was permitted for intolerance, with an attempt to re-escalate recommended. (CSR pp. 39-40, Tables 9-1 and 9-2.)"
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   "group": "Review protocol PICO",
   "state": "not_in_csr",
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   "text": "Matching placebo plus lifestyle intervention. Systematic-review comparator criteria are not reported. (CSR pp. 37, 39-41.)",
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   "text": "Co-primary: percentage change in body weight and \u22655% weight loss at week 68. Confirmatory secondary: \u226510% and \u226515% weight loss; changes in waist circumference, systolic blood pressure, SF-36 physical functioning and IWQOL-Lite-CT physical function at week 68. All eight endpoints were in the multiplicity-controlled hierarchy. (CSR pp. 59-61, 87, Tables 9-8 and 11-1.)"
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   "text": "STEP 1 (NN9536-4373; NCT03548935) was a phase 3a, multicentre, multinational, randomized, double-blind, placebo-controlled trial; 1,961 participants were randomized 2:1 (semaglutide 1,306; placebo 655). It included 68 weeks of treatment and 7 weeks of safety follow-up. (CSR pp. 2, 35, 65-66.)"
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   "alias": "Inclusion criteria table \u2014 number",
   "group": "Inclusion criteria table",
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   "text": "5"
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   "text": "Male or female, age \u226518 years at informed consent; BMI \u226530.0 kg/m\u00b2, or \u226527.0 kg/m\u00b2 with at least one treated or untreated weight-related comorbidity (hypertension, dyslipidaemia, obstructive sleep apnoea or cardiovascular disease); and at least one self-reported unsuccessful dietary effort to lose weight. (CSR p. 37.) The CSR describes STEP 1 eligibility, but does not provide systematic-review selection criteria. (CSR pp. 32, 36-37.)"
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   "text": "The prespecified DEXA sub-population required BMI \u226440.0 kg/m\u00b2 at screening and an acceptable-quality baseline scan confirmed by the imaging laboratory before randomization. It comprised 140 participants (95 semaglutide; 45 placebo). Systematic-review subgroup selection criteria are not reported. (CS",
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   "text": "Trial regimen: semaglutide subcutaneously once weekly, 0.25, 0.5, 1.0 and 1.7 mg for 4 weeks each, then 2.4 mg for 52 weeks. A 1.7 mg maintenance dose was permitted for intolerance, with an attempt to re-escalate recommended. (CSR pp. 39-40, Tables 9-1 and 9-2.)"
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   "text": "Matching placebo plus lifestyle intervention. Systematic-review comparator criteria are not reported. (CSR pp. 37, 39-41.)",
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   "text": "Co-primary: percentage change in body weight and \u22655% weight loss at week 68. Confirmatory secondary: \u226510% and \u226515% weight loss; changes in waist circumference, systolic blood pressure, SF-36 physical functioning and IWQOL-Lite-CT physical function at week 68. All eight endpoints were in the multiplicity-controlled hierarchy. (CSR pp. 59-61, 87, Tables 9-8 and 11-1.)"
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   "text": "STEP 1 (NN9536-4373; NCT03548935) was a phase 3a, multicentre, multinational, randomized, double-blind, placebo-controlled trial; 1,961 participants were randomized 2:1 (semaglutide 1,306; placebo 655). It included 68 weeks of treatment and 7 weeks of safety follow-up. (CSR pp. 2, 35, 65-66.) System",
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   "text": "AE = adverse event; CI = confidence interval; FAS = full analysis set; OR = odds ratio; SAE = serious adverse event. (CSR pp. 25-26, 58.)"
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   "text": "Systematic-review information not reported in supplied CSR. (CSR pp. 1, 32-36.)\n\n\nSearching bibliographic databases\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nSearching clinical trial registries\n\n\n\n\n\nReporting of the literature search\n\nExample of Reporting Clinical Literature Search Methods",
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   "text": "STEP 1 / NN9536-4373. (CSR p. 2.)"
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   "text": "STEP 1 (NN9536-4373; NCT03548935) was a phase 3a, multicentre, multinational, randomized, double-blind, placebo-controlled trial; 1,961 participants were randomized 2:1 (semaglutide 1,306; placebo 655). It included 68 weeks of treatment and 7 weeks of safety follow-up. (CSR pp. 2, 35, 65-66.)"
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   "text": "Second study not reported. (CSR pp. 1, 32.)",
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   "text": "129 sites in 16 countries: Argentina 5, Belgium 5, Bulgaria 5, Canada 7, Denmark 1, Finland 2, France 7, Germany 13, India 13, Japan 5, Mexico 3, Poland 4, Russian Federation 8, Taiwan 1, UK 10, US 40. All sites screened and randomized participants. (CSR p. 2.)"
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   "text": "4 June 2018 (trial initiated). (CSR p. 2.)"
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   "text": "Last enrollment date not reported. (CSR p. 2: trial dates.)",
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   "text": "Second study not reported. (CSR pp. 1, 32.)",
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   "text": "Total randomized N = 1,961: semaglutide 2.4 mg N = 1,306; placebo N = 655 (2:1 allocation). All randomized participants received trial product. (CSR pp. 35, 65.)"
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   "text": "Male or female, age \u226518 years at informed consent; BMI \u226530.0 kg/m\u00b2, or \u226527.0 kg/m\u00b2 with at least one treated or untreated weight-related comorbidity (hypertension, dyslipidaemia, obstructive sleep apnoea or cardiovascular disease); and at least one self-reported unsuccessful dietary effort to lose weight. (CSR p. 37.)"
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   "text": "Key exclusions were HbA1c \u226548 mmol/mol (6.5%) at screening and self-reported body-weight change &gt;5 kg within the previous 90 days; type 2 diabetes was excluded. (CSR pp. 36-37.) Other documented screen-failure criteria included uncontrolled thyroid disease, PHQ-9 score \u226515 and a lifetime suicide attempt. Randomization additionally required a food diary with at most 2 missed days, PHQ-9 &lt;15, no suicidal behaviour, and no type 4 or 5 C-SSRS suicidal ideation between screening and randomization. (CSR pp. 38, 68.)"
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   "text": "Trial regimen: semaglutide subcutaneously once weekly, 0.25, 0.5, 1.0 and 1.7 mg for 4 weeks each, then 2.4 mg for 52 weeks. A 1.7 mg maintenance dose was permitted for intolerance, with an attempt to re-escalate recommended. (CSR pp. 39-40, Tables 9-1 and 9-2.) Both groups received counselling every 4 weeks for a 500 kcal/day deficit and \u2265150 minutes/week of physical activity, with daily food/activity records. (CSR p. 41.)"
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   "text": "Matching placebo by subcutaneous injection once weekly for 68 weeks, with injection volumes matching the fixed 16-week semaglutide escalation and maintenance regimen; both arms received counselling every 4 weeks for a 500 kcal/day energy deficit and \u2265150 minutes/week of physical activity. Placebo and active product had identical appearance. (CSR pp. 35, 39-42.)"
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   "text": "1 week (week \u22121 to week 0). (CSR p. 35, Figure 9-1.)"
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   "text": "No separate run-in phase described. (CSR pp. 35-39.)"
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   "text": "68 weeks: 16-week escalation + 52-week maintenance. (CSR p. 35.)"
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   "text": "7 weeks off treatment; extension planned separately. (CSR pp. 35-36.)"
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  {
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   "text": "STEP 1 journal publication not reported. Final CSR dated 17 August 2020. (CSR p. 2.)",
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   "text": "Second study not reported. (CSR pp. 1, 32.)",
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   "text": "Second study not reported. (CSR pp. 1, 32.)",
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   "text": "STEP 1 (NN9536-4373; NCT03548935) was a phase 3a, multicentre, multinational, randomized, double-blind, placebo-controlled trial; 1,961 participants were randomized 2:1 (semaglutide 1,306; placebo 655). It included 68 weeks of treatment and 7 weeks of safety follow-up. (CSR pp. 2, 35, 65-66.) It was conducted at 129 sites in 16 countries, including 7 Canadian sites and 63 Canadian participants. Trial initiation was 4 June 2018; primary completion 30 March 2020; completion 19 April 2020. (CSR pp. 2, 69.) The main phase is the included study; extension results are to be reported separately. Data"
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   "text": "STEP 1 (NN9536-4373; NCT03548935) was a phase 3a, multicentre, multinational, randomized, double-blind, placebo-controlled trial; 1,961 participants were randomized 2:1 (semaglutide 1,306; placebo 655). It included 68 weeks of treatment and 7 weeks of safety follow-up. (CSR pp. 2, 35, 65-66.) It was conducted at 129 sites in 16 countries, including 7 Canadian sites and 63 Canadian participants. Trial initiation was 4 June 2018; primary completion 30 March 2020; completion 19 April 2020. (CSR pp. 2, 69.) The main phase is the included study; extension results are to be reported separately. Data"
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   "text": "Adults aged \u226518 years with BMI \u226530 kg/m\u00b2, or \u226527 kg/m\u00b2 with hypertension, dyslipidaemia, obstructive sleep apnoea or cardiovascular disease, and \u22651 unsuccessful dietary weight-loss effort; type 2 diabetes excluded. (CSR pp. 36-37.) Additional reported exclusions include HbA1c \u22656.5%, &gt;5 kg weight change within 90 days, uncontrolled thyroid disease, PHQ-9 \u226515 at screening and lifetime suicide attempt. Randomization required food-diary completion, PHQ-9 &lt;15 and no specified suicidal behaviour/ideation. The full protocol exclusion list is referenced but not reproduced in the supplied report."
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   "text": "Trial regimen: semaglutide subcutaneously once weekly, 0.25, 0.5, 1.0 and 1.7 mg for 4 weeks each, then 2.4 mg for 52 weeks. A 1.7 mg maintenance dose was permitted for intolerance, with an attempt to re-escalate recommended. (CSR pp. 39-40, Tables 9-1 and 9-2.) Both groups received counselling every 4 weeks for a 500 kcal/day deficit and \u2265150 minutes/week of physical activity, with daily food/activity records. (CSR p. 41.) Allocation was centralized via IWRS, with subjects, investigators and sponsor blinded; products had identical appearance. (CSR p. 42.)"
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   "text": "Co-primary: percentage change in body weight and \u22655% weight loss at week 68. Confirmatory secondary: \u226510% and \u226515% weight loss; changes in waist circumference, systolic blood pressure, SF-36 physical functioning and IWQOL-Lite-CT physical function at week 68. All eight endpoints were in the multiplicity-controlled hierarchy. (CSR pp. 59-61, 87, Tables 9-8 and 11-1.) Supportive/exploratory endpoints included \u226520% weight loss, BMI, lipids, glucose measures, body composition, other quality-of-life scores, medication use, work productivity, urinary incontinence and treatment discontinuation; safet"
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   "text": "Body-weight change (%) and \u22655% loss* (CSR pp. 59-61, 87.)"
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   "text": "Week 68 (CSR pp. 59-61, 87.)"
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   "text": "Co-primary* (CSR pp. 59-61, 87.)"
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   "text": "\u226510%/\u226515% loss; waist circumference; systolic BP* (CSR pp. 59-61, 87.)"
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   "text": "Week 68 (CSR pp. 59-61, 87.)"
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   "text": "Confirmatory secondary* (CSR pp. 59-61, 87.)"
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   "text": "The primary treatment-policy estimand evaluated all randomized participants irrespective of treatment discontinuation or use of other anti-obesity therapy; the secondary hypothetical estimand assumed adherence to randomized therapy without other anti-obesity treatment. (CSR pp. 33-34.) Week-68 percentage body-weight change was analysed by ANCOVA with randomized treatment as factor and baseline body weight as covariate. Binary \u22655% weight-loss response used logistic regression with the same factor and covariate. Missing week-68 outcomes were imputed 1,000 times from retrieved participants in the"
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   "text": "Body-weight change (%) (CSR pp. 93, 333-334, 346.)"
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   "text": "ANCOVA (CSR pp. 93, 333-334, 346.)"
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   "text": "Treatment factor; baseline weight covariate (CSR pp. 93, 333-334, 346.)"
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   "text": "Jump-to-reference multiple imputation; single imputation S1 and S2 with weight regain; MMRM; two-way tipping-point multiple imputation. (CSR pp. 90-92, 334.)"
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   "text": "\u22655%, \u226510% and \u226515% body-weight loss at week 68; changes in waist circumference, systolic blood pressure, SF-36 physical functioning and IWQOL-Lite-CT physical function at week 68. (CSR pp. 59-60, 87.)"
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   "text": "Binary weight-loss responses: logistic regression. Continuous changes: ANCOVA. (CSR pp. 93, 371, 418, 462, 488.)"
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   "text": "Randomized treatment as factor; baseline body weight as covariate for weight-loss responses, and the corresponding baseline measure for continuous changes. (CSR pp. 93, 371, 418, 462, 488.)"
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   "text": "Missing week-68 outcomes: retrieved-dropout multiple imputation (1,000 imputations) from the same randomized arm. (CSR pp. 93, 371, 418, 462, 488.)"
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   "text": "For \u22655% response: jump-to-reference, S1, S2, MMRM, non-responder and tipping-point analyses. Waist and physical-function sensitivity analyses are reported separately. (CSR pp. 94, 97, 114, 119, 346.)"
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   "text": "Planned N=1,950 (1,300 semaglutide; 650 placebo), chosen to support safety exposure/regulatory requirements; reported effective power was 99% for eight hierarchical efficacy endpoints. The IWQOL-Lite-CT power calculation was updated before unblinding without changing sample size. Detailed effect-size/variance assumptions are referenced to the protocol/SAP but not provided in the supplied report. (CSR pp. 36, 58, 62.)"
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   "text": "Final superiority analyses used a prespecified hierarchy: percentage weight change; \u22655%, \u226510% and \u226515% weight loss; waist circumference; systolic blood pressure; SF-36 physical functioning; and IWQOL-Lite-CT physical function. Each had local two-sided alpha 0.05, with multiplicity controlled through hierarchical testing. All eight tests met superiority (p&lt;0.0001); displayed p-values are labelled unadjusted. (CSR p. 87, Table 11-1.) ANCOVA was used for continuous changes and logistic regression for binary responses, with randomized treatment and the relevant baseline covariate. (CSR pp. 93, "
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   "text": "No efficacy subgroup effect estimates or subgroup interaction tests are reported in the supplied CSR. The DEXA sub-study was a prespecified subset, with 140 participants (95 semaglutide; 45 placebo), not an efficacy interaction analysis. (CSR pp. 35, 72, 84-85.)"
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   "text": "FAS: all randomized participants, evaluated as randomized under the intention-to-treat principle. SAS: all randomized participants exposed to \u22651 randomized dose, evaluated as treated. DXA: the FAS subset with an acceptable-quality baseline DEXA scan. (CSR p. 58.) FAS and SAS each contained 1,961 participants (semaglutide 1,306; placebo 655); DXA contained 140 (95; 45). A separate per-protocol set is not defined. (CSR pp. 58, 65, 72.) In-trial observations ran from randomization to last contact; on-treatment periods included 2 weeks for efficacy/selected safety measures or 7 weeks for AEs/adjud"
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   "text": "Full analysis set (FAS). (CSR p. 58.)"
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   "text": "All randomized participants; analysed as randomized (intention to treat). N = 1,961: semaglutide 1,306; placebo 655. (CSR pp. 58, 65.)"
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   "text": "Efficacy analyses, including treatment-policy estimates and observed efficacy summaries. (CSR pp. 58, 87, 93.)"
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   "text": "All randomized participants exposed to \u22651 dose; analysed as treated. N = 1,961: semaglutide 1,306; placebo 655. (CSR pp. 58, 65.)"
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   "text": "Safety evaluation; observation periods depended on the safety outcome. (CSR pp. 58, 128.)"
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   "text": "FAS subset with a baseline DEXA scan of acceptable quality. N = 140: semaglutide 95; placebo 45. (CSR pp. 58, 72.)"
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   "text": "Body-weight change (%) at week 68 (CSR p. 87.)"
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   "text": "Body-weight change (%) at week 68. At week 68, treatment-policy estimated mean body-weight change was \u221214.85% with semaglutide versus \u22122.41% with placebo; difference \u221212.44 percentage points (95% CI \u221213.37 to \u221211.51; p&lt;0.0001). The \u22655% weight-loss odds ratio was 11.22 (95% CI 8.88 to 14.19; p&lt;0.0001). (CSR pp. 87, 89, 93; Tables 11-1 and 11-2.) Sensitivity ETDs: jump-to-reference \u221211.94 (95% CI \u221212.83 to \u221211.04); single-imputation S1 \u221212.46 (\u221213.32 to \u221211.61); S2 \u221212.35 (\u221213.21 to \u221211.50); MMRM \u221212.83 (\u221213.70 to \u221211.96), all p&lt;0.0001. No tipping point was reached over tested penalties"
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   "text": "Body-weight response at week 68. Observed \u22655% loss: 1,047/1,212 (86.4%) versus 182/577 (31.5%). Sensitivity ORs: jump-to-reference 10.22 (95% CI 8.10-12.89), S1 12.38 (9.90-15.48), S2 12.10 (9.68-15.11), MMRM 14.65 (11.65-18.42) and non-responder imputation 10.56 (8.48-13.14), all p&lt;0.0001. (CSR pp. 344, 346, Tables 14.2.24 and 14.2.27.) For \u226510% loss, observed 838/1,212 (69.1%) versus 69/577 (12.0%); OR 14.68 (11.08-19.44). For \u226515% loss, 612/1,212 (50.5%) versus 28/577 (4.9%); OR 19.26 (12.89-28.76); both p&lt;0.0001 within the hierarchy. \u226520% loss was supportive: 388/1,212 (32.0%) versus"
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   "text": "Safety focus areas included GI and gallbladder disorders, pancreatitis, cardiovascular disorders, neoplasms, hepatic events, renal failure, hypoglycaemia, injection-site/allergic reactions, psychiatric disorders and medication errors. Gallbladder disorders: 34 (2.6%) versus 8 (1.2%); adjudicated pancreatitis: 3 (0.2%) versus 0. (CSR p. 129, Table 12-2.) Pulse-rate difference at week 68 was +4.26 beats/min (95% CI 3.38 to 5.15). (CSR p. 187.)"
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