Discontinuation rates, read honestly
Roughly four to seven per cent of trial participants discontinued for adverse events, mostly gastrointestinal, mostly during escalation. That is the empirical size of the…
Titration
Page 10 of 14 of this archive, newest first.
Side effects, cost, supply, target: four reasons with four trajectories
Cost is the modal reason for discontinuation in every dataset we have seen, and it is absent from the clinical literature.
The dose that got you here and the dose that keeps you here
The commonest real-world strategy in this drug class is the least studied one.
What SURPASS-4 tells us about maintenance, and what it does not
A survey of the maintenance evidence, which is shorter than the survey of the withdrawal evidence.
Why your endoscopist wants to know about your injection
Holding a dose before a procedure has a kinetic problem: a weekly drug with a seven-day half-life cannot be cleared by skipping one injection.
Discontinuation rates, read honestly
Trial discontinuation figures are a floor, not an estimate: trial populations are supported in ways ordinary patients are not.
Escalating onto a rising curve
We work the arithmetic out in full, because it is arithmetic and it is short.
Hydration, protein and the two failures that compound each other
Almost nothing in the standard management repertoire has been tested in a randomised trial in this specific population. We say what is extrapolated and from where.
Side effects, cost, supply, target: four reasons with four trajectories
Real-world persistence figures, with their definitions stated, because the definitions are doing most of the work.
What the placebo arms of the withdrawal trials actually tell us
What was withdrawn, from whom, after how long, and what was measured afterwards.
What STEP 4 and SURMOUNT-4 actually established
A plateau at an intermediate dose and a plateau at the maximum dose look identical from the outside and mean different things.
Do you need the top of the ladder?
The dose-response curve in this class flattens near its top. That has direct consequences for whether the final rung is worth climbing.
Target dose, effective dose, and the distance between them
The dose-response curve in this class flattens near its top. That has direct consequences for whether the final rung is worth climbing.
What actually helps, ranked by evidence
The intervention with the clearest evidence is the one nobody frames as an intervention: adjusting the dose.
The lowest effective dose is a real concept with almost no data behind it
Dose reduction is not withdrawal, and the trials that tested withdrawal cannot be read as testing it.
What STEP 4 tells us about maintenance, and what it does not
A survey of the maintenance evidence, which is shorter than the survey of the withdrawal evidence.
The effect profile, predicted from an expression map
Delayed gastric emptying is a mechanism that becomes an adverse effect above a threshold. It is not a complication in the ordinary sense.
Discontinuation rates, read honestly
An effect is dose-limiting when it prevents adequate intake, prevents normal activity, or produces a risk of its own. Discomfort alone is not the test.
Maintenance dosing: what is licensed, what is practised, and what is evidenced
A survey of the maintenance evidence, which is shorter than the survey of the withdrawal evidence.
Maintenance dosing: what is licensed, what is practised, and what is evidenced
Dose reduction is not withdrawal, and the trials that tested withdrawal cannot be read as testing it.