Maximum tolerated is not maximum approved
Weight reduction in the long programmes flattens at roughly sixty to seventy-two weeks. The timing is consistent, predictable and almost never mentioned in advance.
Recent work
131 piecesThe trade has decided the ceiling is arbitrary. The trials disagree.
Where the curve flattens, what flattens with it, and what does not.
The mechanism behind the mechanism
The clinical effect profile is almost fully predictable from where the receptor is expressed, which is unusual and useful.
GIP was a failed target for thirty years. Then it was not.
What adding GIP activity does, on the current evidence, and what remains unresolved.
The eighteenth month, and the conversation that should have happened in the third
Two withdrawal-design trials tell us what happens when treatment stops. Neither tells us what the lowest effective maintenance dose is.
Where the receptor is: a tissue-by-tissue account of liraglutide’s reach
The central effects are not a bonus. On the current evidence they are the principal mechanism of weight loss.
The upper rungs, ranked by evidence
Where the curve flattens, what flattens with it, and what does not.
What STEP 4 and SURMOUNT-4 actually established
What the trials measured was continuation against withdrawal. What patients want to know is continuation at a lower dose, and that study has largely not been done.
What the trials counted as intolerance
The ceiling varies severalfold between people, and nothing measurable at baseline predicts where it sits.
Reading a barrel: the graduation that is not the one you think
The graduation interval differs between barrel sizes, and a 1 mL barrel is frequently marked in two-unit steps. Reading one as though it were marked in single units halves…
Pancreatitis, obstruction, gallbladder: three things nausea can be
Rapid weight loss by any means raises gallstone risk. Separating that from a direct drug effect requires a comparator, and the trials have one.
Storage after reconstitution, and the evidence behind the numbers
Sharps disposal is a legal obligation in most jurisdictions and a safety obligation everywhere. Household waste is not a route.
What the trials adjudicated, and how
We give background rates alongside trial rates, because an event occurring during treatment is not thereby caused by it.
A percentage is not a specification
This piece takes the measurement apart into the decisions it is made of, because each decision moves the answer.
Diminishing returns, quantified
The ceiling in this class is anatomical: the same receptor populations that suppress appetite provoke nausea, and they saturate together.
Reading a barrel: the graduation that is not the one you think
Dead space in the needle hub is a real and calculable loss, and it matters more at small volumes than anybody expects.
Hydration, protein and the two failures that compound each other
The intervention with the clearest evidence is the one nobody frames as an intervention: adjusting the dose.
Hydration, protein and the two failures that compound each other
The intervention with the clearest evidence is the one nobody frames as an intervention: adjusting the dose.
Escalating past the approved maximum, examined honestly
We looked at what the dose-ranging data supports about going higher, and it is thinner and less flattering than the market assumes.
Calibrated, qualified, accredited: three words that are not synonyms
System suitability is the set of checks demonstrating that the instrument and method were performing adequately when your sample was injected. It is recorded as a matter of…