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In many studies, the potential mediator is measured repeatedly over time, and we expect feedback between other post\u2010treatment covariates and the mediator. Randomized interventional (also called stochastic) effects have been proposed for defining causal mediation estimands in longitudinal settings, because they are identifiable in the presence of post\u2010treatment mediator\u2010outcome confounders. In this article, we use the interventional effects framework to investigate the mediating pathways in a clinical trial that compared the effect of semaglutide versus placebo on the histological resolution of nonalcoholic steatohepatitis (NASH). We define and identify various interventional direct and indirect effects relevant to the research question. For estimation, we propose an efficient and multiply robust Targeted Minimum Loss Estimator (TMLE), and we showcase the theoretical properties of the estimator in a simulation study.<\/jats:p>","DOI":"10.1002\/sim.70305","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T13:05:23Z","timestamp":1762520723000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Estimation of Interventional Effects in Clinical Trials With a Repeatedly Measured Mediator"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1237-685X","authenticated-orcid":false,"given":"Marie","family":"Skov Breum","sequence":"first","affiliation":[{"name":"Section of Biostatistics, Department of Public Health University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mads","family":"Sundby Palle","sequence":"additional","affiliation":[{"name":"Novo Nordisk A\/S  Bagsv\u00e6rd Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Explanation in Causal Inference: Methods for Mediation and Interaction","author":"VanderWeele T. 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