Every fortnight, every third week, seasonally: an unstudied practice
What the exposure arithmetic says about a fortnightly schedule, and where the arithmetic stops being informative.
Titration
Page 13 of 14 of this archive, newest first.
What happens when the drug is taken away: three randomised answers
The evidence on stopping is better than the evidence on almost anything else in this field, because somebody deliberately randomised it.
The mechanism behind the mechanism
A single drug producing both constipation and diarrhoea looks contradictory until the motility data is read properly.
The supply gap as a clinical event
Cost is the modal reason for discontinuation in every dataset we have seen, and it is absent from the clinical literature.
Why your endoscopist wants to know about your injection
This is the single interaction with ordinary medical care that patients most need to disclose, and it is the one most often not asked about.
Tolerability is the ceiling, and the ceiling is personal
The ceiling varies severalfold between people, and nothing measurable at baseline predicts where it sits.
Side effects, cost, supply, target: four reasons with four trajectories
Why the reason for stopping changes what happens afterwards.
Holidays, surgery, sickness: interruption in practice
The convention — resume lower, re-escalate — is not caution. It follows directly from the elimination half-life.
What a month without the drug does to tolerability
The convention — resume lower, re-escalate — is not caution. It follows directly from the elimination half-life.
What SURMOUNT-1 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.
What the trials adjudicated, and how
The features that should prompt urgent assessment, stated once and plainly.
Diminishing returns, quantified
The ceiling in this class is anatomical: the same receptor populations that suppress appetite provoke nausea, and they saturate together.
What TRIUMPH-3 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.
What STEP 4 and SURMOUNT-4 actually established
The dose-response curve in this class flattens near its top. That has direct consequences for whether the final rung is worth climbing.
From 0.25 to 2.4: reading a ladder as a series of ratios
What the published pharmacokinetics permit, what the labels state, and where the two diverge.
Gallstones during rapid weight loss: drug, or weight loss?
We give background rates alongside trial rates, because an event occurring during treatment is not thereby caused by it.
The interventions with trial support, and the much longer list without
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.
The label says four weeks. The clinic says whatever holds.
What the regulatory dossiers actually contain on dose selection is remarkably thin, and worth knowing before treating the ladder as settled science.
The trade has decided the ceiling is arbitrary. The trials disagree.
The ceiling in this class is anatomical: the same receptor populations that suppress appetite provoke nausea, and they saturate together.
The shortage years, and what they taught about interruption
A supply interruption is a discontinuation with no notice, no taper and no plan. That is a distinct clinical situation.