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.
Discontinuation
Page 3 of 4 of this archive, newest first.
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.
Why people actually stop, in the order they actually stop
A supply interruption is a discontinuation with no notice, no taper and no plan. That is a distinct clinical situation.
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.
Randomised withdrawal is the cleanest design in this field and the least discussed
The regain trajectories, arm by arm, with the estimands named.
Weight regain is not a failure of willpower and it is not a mystery
The variance around the mean regain trajectory is large and unexplained, exactly as it is for the weight loss.
The dose that got you here and the dose that keeps you here
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
Real-world persistence figures, with their definitions stated, because the definitions are doing most of the work.
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.
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.
Every fortnight, every third week, seasonally: an unstudied practice
An absence of evidence is not evidence of harm. It is also not a licence.
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.
A year after stopping: what the trials found at the far end
The physiology of regain was described a decade before these drugs, and it explains the trajectory without invoking anything specific to them.
What STEP 5 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.
Weight regain is not a failure of willpower and it is not a mystery
The variance around the mean regain trajectory is large and unexplained, exactly as it is for the weight loss.
Seasonal use, holiday use, and the honest state of the evidence
The vocabulary is borrowed, the rationale is usually mechanistic, and the outcome data does not exist.
Why people actually stop, in the order they actually stop
A supply interruption is a discontinuation with no notice, no taper and no plan. That is a distinct clinical situation.
Why people actually stop, in the order they actually stop
The trials studied planned withdrawal. Almost nobody stops that way.
What the placebo arms of the withdrawal trials actually tell us
Three randomised withdrawal designs have tested what happens when treatment stops. Their results are consistent and they are consistently misreported.