The escalation table is the thinnest page in the label
The published ladder exists because a protocol needed a single number. Practice has never followed it exactly, and the regulatory file never assumed it would.
Pharmacology in 2024
Page 5 of 5 of this archive, newest first.
Why receptor selectivity is the least discussed number in incretin pharmacology
Selectivity, potency and efficacy are three different measurements. The trade routinely reports none of them.
Albumin, fatty-acid chains, and the engineering that made a weekly incretin possible
The molecular engineering that turned a peptide with a two-minute half-life into a once-weekly drug.
Target dose, effective dose, and the distance between them
Two withdrawal-design trials tell us what happens when treatment stops. Neither tells us what the lowest effective maintenance dose is.
Stepping down is part of titration
The practice is near-universal, clinically sensible, and supported by observational data rather than randomised comparison. We say which is which.
The eighteenth month, and the conversation that should have happened in the third
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.
Forty-four per cent: reading the nausea figure properly
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.
Background rates, and why they matter for attribution
The features that should prompt urgent assessment, stated once and plainly.
The tolerability data everybody quotes and nobody reads
Almost every figure in circulation about tolerability comes from six publications. This is what they say.