SURPASS-2 was built to answer the stopping question, and it did
What was withdrawn, from whom, after how long, and what was measured afterwards.
Recent work
61 piecesFour millimetres is enough, and the data says so
Longer needles reach muscle in lean limbs, and intramuscular delivery of a long-acting depot changes absorption in ways nobody wants.
In-use periods, and the ones nobody can give you
A needle blunts on first use. Reuse is uncomfortable, and it is a documented contributor to lipohypertrophy.
What STEP 2 tells us about maintenance, and what it does not
What the labels permit, what clinicians do, and the size of the gap between them.
Aseptic technique for people who were never taught it
A needle blunts on first use. Reuse is uncomfortable, and it is a documented contributor to lipohypertrophy.
Continued treatment against continued placebo: the comparison that settled it
The regain trajectories, arm by arm, with the estimands named.
The dose that got you here and the dose that keeps you here
A survey of the maintenance evidence, which is shorter than the survey of the withdrawal evidence.
The convention nobody explains before handing over the vial
A unit is a volume. A dose is a mass. The bridge between them is concentration, and concentration is a number somebody has to calculate.
The shortage years, and what they taught about interruption
Why the reason for stopping changes what happens afterwards.
What SURMOUNT-3 tells us about maintenance, and what it does not
The commonest real-world strategy in this drug class is the least studied one.
The withdrawal trials, read as designs rather than warnings
Three randomised withdrawal designs have tested what happens when treatment stops. Their results are consistent and they are consistently misreported.
What SURMOUNT-1 tells us about maintenance, and what it does not
Every withdrawal trial compared full dose against nothing. The clinically interesting comparison — full dose against a reduced one — has not been randomised.
The supply gap as a clinical event
A supply interruption is a discontinuation with no notice, no taper and no plan. That is a distinct clinical situation.
Thiamine and the vomiting patient
What the trials measured, which in the case of micronutrients is very little.
The lowest effective dose is a real concept with almost no data behind it
The commonest real-world strategy in this drug class is the least studied one.
Falling ferritin is not always falling iron
A substantial proportion of the abnormal results generated during rapid weight loss are consequences of the weight loss rather than findings about the person.
Maintenance dosing: what is licensed, what is practised, and what is evidenced
Every withdrawal trial compared full dose against nothing. The clinically interesting comparison — full dose against a reduced one — has not been randomised.
Why people actually stop, in the order they actually stop
A supply interruption is a discontinuation with no notice, no taper and no plan. That is a distinct clinical situation.
Storage after reconstitution, and the evidence behind the numbers
The air shot before a pen injection removes air from the cartridge and confirms flow. Skipping it can mean a materially reduced dose, and it is skipped constantly.
The dose that got you here and the dose that keeps you here
A survey of the maintenance evidence, which is shorter than the survey of the withdrawal evidence.