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.
Dosing
Page 18 of 31 of this archive, newest first.
The shortage years, and what they taught about interruption
The trials studied planned withdrawal. Almost nobody stops that way.
Tapering: a word borrowed from drugs with withdrawal syndromes
What a slow reduction could plausibly buy, and what it certainly cannot prevent.
What the new Australia guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
What the trials counted as intolerance
The ceiling varies severalfold between people, and nothing measurable at baseline predicts where it sits.
What the new Italy guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
India pharmacy body issues counselling standards for tirzepatide initiation
The evidence base is thin and the document says so, which is to its credit.
Nigeria pharmacy body issues counselling standards for semaglutide initiation
The evidence base is thin and the document says so, which is to its credit.
Spain pharmacy body issues counselling standards for semaglutide initiation
The evidence base is thin and the document says so, which is to its credit.
Tolerability is the ceiling, and the ceiling is personal
Trial discontinuation figures are a floor, not an estimate: trial populations are supported in ways ordinary patients are not.
Stepping down is part of titration
Every major phase 3 protocol in this class allowed escalation to be delayed for tolerability. Almost no product label explains the mechanics of doing so.
The United Kingdom pharmacy body issues counselling standards for tirzepatide initiation
The evidence base is thin and the document says so, which is to its credit.
Do you need the top of the ladder?
What the trials measured was continuation against withdrawal. What patients want to know is continuation at a lower dose, and that study has largely not been done.
The trade has decided the ceiling is arbitrary. The trials disagree.
Higher doses of these molecules have been studied. In general they produced modest additional efficacy and disproportionate additional symptom burden, which is why the…
Side effects, cost, supply, target: four reasons with four trajectories
Why the reason for stopping changes what happens afterwards.
Maximum tolerated is not maximum approved
A plateau at an intermediate dose and a plateau at the maximum dose look identical from the outside and mean different things.
What the new Germany guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
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 the new Norway guidance says about stopping
The evidence base is thin and the document says so, which is to its credit.
Attribution is the hard part
Pancreatitis is rare, was adjudicated in the outcome programmes, and did not show the imbalance early case reports suggested.