What the placebo arms of the withdrawal trials actually tell us
What was withdrawn, from whom, after how long, and what was measured afterwards.
Discontinuation
Page 2 of 4 of this archive, newest first.
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.
What happens when the drug is taken away: three randomised answers
The regain trajectories, arm by arm, with the estimands named.
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.
The lead-in, the randomisation, and the year that followed
A withdrawal trial answers a narrower question than it appears to. This piece states which question.
The shortage years, and what they taught about interruption
Cost is the modal reason for discontinuation in every dataset we have seen, and it is absent from the clinical literature.
The shortage years, and what they taught about interruption
Real-world persistence figures, with their definitions stated, because the definitions are doing most of the work.
The withdrawal trials, read as designs rather than warnings
The evidence on stopping is better than the evidence on almost anything else in this field, because somebody deliberately randomised it.
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.
The lowest effective dose is a real concept with almost no data behind it
A survey of the maintenance evidence, which is shorter than the survey of the withdrawal evidence.
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.
A design note on withdrawal trials, and why the run-in matters
The regain trajectories, arm by arm, with the estimands named.
What TRIUMPH-3 tells us about maintenance, and what it does not
Every withdrawal trial compared full dose against nothing. The clinically interesting comparison — full dose against a reduced one — has not been randomised.
Side effects, cost, supply, target: four reasons with four trajectories
A supply interruption is a discontinuation with no notice, no taper and no plan. That is a distinct clinical situation.
The supply gap as a clinical event
Why the reason for stopping changes what happens afterwards.
Two-thirds back: the extension nobody expected to be the headline
A withdrawal trial answers a narrower question than it appears to. This piece states which question.
Why people actually stop, in the order they actually stop
Real-world persistence figures, with their definitions stated, because the definitions are doing most of the work.
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.
Every fortnight, every third week, seasonally: an unstudied practice
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.