What SELECT 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.
Patient experience
Page 3 of 8 of this archive, newest first.
Fat mass fell more than lean mass. That is the finding, and it is not the headline.
What was pre-specified, what was exploratory, and what was calculated afterwards by people who did not run the trial.
SURPASS-3 was built to answer the stopping question, and it did
Three randomised withdrawal designs have tested what happens when treatment stops. Their results are consistent and they are consistently misreported.
Continued treatment against continued placebo: the comparison that settled it
The evidence on stopping is better than the evidence on almost anything else in this field, because somebody deliberately randomised it.
The shortage years, and what they taught about interruption
A supply interruption is a discontinuation with no notice, no taper and no plan. That is a distinct clinical situation.
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.
The supply gap as a clinical event
Why the reason for stopping changes what happens afterwards.
What the placebo arms of the withdrawal trials actually tell us
What was withdrawn, from whom, after how long, and what was measured afterwards.
Coming off: what the pharmacology permits
What a slow reduction could plausibly buy, and what it certainly cannot prevent.
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.
The one randomised trial that combined an incretin with supervised exercise
The recommendation survives scrutiny. The reasoning offered for it frequently does not.
The substudies, read properly: who was scanned, when, and with what
The composition data comes from imaging substudies enrolling a few score participants at selected sites. It is the best evidence available and it is thin.
The advice is mostly reasonable. The certainty is not earned.
Grading six widely repeated claims against the studies actually behind them.
Why "muscle-sparing" is a marketing term and not a measurement
A tour of the source literatures, with an assessment of how far each legitimately reaches.
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.
Why "muscle-sparing" is a marketing term and not a measurement
Grading six widely repeated claims against the studies actually behind them.
STEP 2 was built to answer the stopping question, and it did
A withdrawal trial answers a narrower question than it appears to. This piece states which question.
The advice is mostly reasonable. The certainty is not earned.
The gap between a defensible recommendation and a confident one is where most of the harm in this subject lives.
The one randomised trial that combined an incretin with supervised exercise
Mass and function are different endpoints and training affects them differently. Most coverage treats them as one.
Two-thirds back: the extension nobody expected to be the headline
The evidence on stopping is better than the evidence on almost anything else in this field, because somebody deliberately randomised it.