Severity grading, and the gap between a grade and an experience
Almost every figure in circulation about tolerability comes from six publications. This is what they say.
Anneke van der Molen
Page 6 of 8 of this archive, newest first.
Archive — page 6
148 piecesSURMOUNT-4 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.
EGFR, cystatin C, and the check on the check
Estimated glomerular filtration rate is a calculation with muscle mass in the denominator of its assumptions. In this population that matters.
Why the fifth week of a dulaglutide dose feels different from the first
An accumulation model, drawn from published parameters, with its assumptions stated.
The interventions with trial support, and the much longer list without
We separate what is supported, what is reasonable, and what is folklore, and we do not pretend the boundaries are crisp.
What we would need to measure to explain the response distribution
A catalogue of open questions, with an assessment of how likely each is to be resolved.
The kidney, the heart and the receptor nobody was looking for
The central effects are not a bonus. On the current evidence they are the principal mechanism of weight loss.
What we would need to randomise to answer this properly
One randomised trial has combined a GLP-1 receptor agonist with supervised exercise. Its result is the single most useful piece of evidence in this area.
PIONEER 6 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.
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.
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.
The kidney, the heart and the receptor nobody was looking for
The central effects are not a bonus. On the current evidence they are the principal mechanism of weight loss.
Holding the dose before surgery: for whom, for how long
The evidence is real, modest, and mostly retrospective. The guidance is correspondingly cautious and has been revised toward individualisation.
The tolerability data everybody quotes and nobody reads
Trial adverse-event tables count episodes reported to a study nurse. They are the best data we have and they systematically under-record the mundane.
Stepping down against stopping: two decisions treated as one
The best argument for tapering is behavioural rather than pharmacological, and it deserves to be made on its own terms.
Beta-arrestin, cAMP, and the part of exenatide’s mechanism nobody quotes
The receptor is expressed in more tissues than the popular account allows, and that is the whole story.
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 interventions with trial support, and the much longer list without
The intervention with the clearest evidence is the one nobody frames as an intervention: adjusting the dose.
Seasonal use, holiday use, and the honest state of the evidence
An absence of evidence is not evidence of harm. It is also not a licence.
What actually helps, ranked by evidence
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.