The lowest effective dose is a real concept with almost no data behind it
Every withdrawal trial compared full dose against nothing. The clinically interesting comparison — full dose against a reduced one — has not been randomised.
STEP programme
Page 9 of 18 of this archive, newest first.
SURPASS-4 extension data: what happens after the trial stops
A design note rather than a result: what the comparator was, and what that permits you to conclude.
SURMOUNT-2 extension data: what happens after the trial stops
A design note rather than a result: what the comparator was, and what that permits you to conclude.
SURMOUNT-OSA misses on a secondary endpoint the coverage has not mentioned
A design note rather than a result: what the comparator was, and what that permits you to conclude.
What SURMOUNT-1 tells us about maintenance, and what it does not
The commonest real-world strategy in this drug class is the least studied one.
LEADER extension data: what happens after the trial stops
A design note rather than a result: what the comparator was, and what that permits you to conclude.
Two-thirds back: the extension nobody expected to be the headline
The evidence on stopping is better than the evidence on almost anything else in this field, because somebody deliberately randomised it.
Fat mass fell more than lean mass. That is the finding, and it is not the headline.
The composition data comes from imaging substudies enrolling a few score participants at selected sites. It is the best evidence available and it is thin.
SURPASS-2 misses on a secondary endpoint the coverage has not mentioned
A design note rather than a result: what the comparator was, and what that permits you to conclude.
The advice is mostly reasonable. The certainty is not earned.
Almost every practical recommendation in circulation was established in a population that does not resemble the people now following it.
STEP 8 misses on a secondary endpoint the coverage has not mentioned
A design note rather than a result: what the comparator was, and what that permits you to conclude.
Continued treatment against continued placebo: the comparison that settled it
What was withdrawn, from whom, after how long, and what was measured afterwards.
STEP 2 extension data: what happens after the trial stops
A design note rather than a result: what the comparator was, and what that permits you to conclude.
What the pharmacokinetics permit and what they cannot tell you
A great deal of practice has grown up around intermittent schedules. The randomised evidence for any of them is, as far as the Journal can establish, nil.
SURPASS-3 misses on a secondary endpoint the coverage has not mentioned
A design note rather than a result: what the comparator was, and what that permits you to conclude.
SURMOUNT-OSA misses on a secondary endpoint the coverage has not mentioned
A design note rather than a result: what the comparator was, and what that permits you to conclude.
What TRIUMPH-1 tells us about maintenance, and what it does not
Dose reduction is not withdrawal, and the trials that tested withdrawal cannot be read as testing it.
TRIUMPH-3 extension data: what happens after the trial stops
A design note rather than a result: what the comparator was, and what that permits you to conclude.
STEP 5 misses on a secondary endpoint the coverage has not mentioned
A design note rather than a result: what the comparator was, and what that permits you to conclude.
SURPASS-3 misses on a secondary endpoint the coverage has not mentioned
A design note rather than a result: what the comparator was, and what that permits you to conclude.