Semaglutide titration: 0.25→0.5→1.0→1.7→2.4mg optimal schedule

Dr.PainCLE said:

Dr.Martinez said: ...but the FDA says semaglutide...

Same position here, arrived at the long way round. The dose-response is real but shallow at the top. Across STEP 1 and STEP 4 the gap between 1.7mg and 2.4mg is a couple of percentage points of body weight on average, and the average is carrying a wide spread — plenty of people at 1.7mg sit above the 2.4mg mean. If a dose is working and tolerable, "working" is the relevant variable, not "maximal".

Worth separating that from the titration schedule, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

A narrower follow-up, since the general answer is now clear:

What the dose-response curve actually looks like above 1.7mg, because the trial means hide how few people account for the extra loss?

PedsEndoPhilly said:

The dose-response is real but shallow at the top.

Pushing back on PedsEndoPhilly here. The mechanism that matters here is not stomach emptying, it is central. GLP-1 receptor agonism in the arcuate nucleus stimulates POMC neurons and suppresses AgRP/NPY signalling, which is why the effect is appetite and food salience rather than physical fullness. Delayed gastric emptying largely tachyphylaxes over the first months; the appetite effect does not.

PedsEndoPhilly said:

The dose-response is real but shallow at the top.

That is right for the weekly injectables. For the daily agents the interval logic is different and the four-week convention does not transfer.

Moderator note: the sourcing question belongs in the vendor section and has been split out. No action needed from anybody.