In multi-intervention stepped-wedge trials, the constant effect estimator is a non-uniform weighted average of exposure-time-specific effects, so it can be biased and even opposite in sign to all true effects.
Design and analysis of stepped wedge cluster randomized trials.Contemporary Clinical Trials 2007; 28(2): 182-191
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Time-varying treatment effect models in stepped-wedge cluster-randomized trials with multiple interventions
In multi-intervention stepped-wedge trials, the constant effect estimator is a non-uniform weighted average of exposure-time-specific effects, so it can be biased and even opposite in sign to all true effects.