Semaglutide 1.0mg for maintenance — 12 month update

PharmacoVig_BOS said:

One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are.

The regain framing needs pushing back on. Two thirds regained means one third did not, and the trial provided no ongoing support to either group. Treating regain as pharmacologically inevitable is as unsupported as treating maintenance as automatic.

One concrete data point for the thread. For anyone assembling their own picture: Tmax is one to three days, terminal half-life about 165 to 170 hours, steady state at four to five weeks, and subcutaneous bioavailability near 89%. Those four numbers explain most of the questions people ask about timing.

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

Ask again with the specifics and you will get a better answer than this one.

julia.endo said:

The regain framing needs pushing back on.

There is a second half to this that has not been said yet. 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".

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

Whether extending the interval works as well as reducing the dose, since they are not the same intervention pharmacologically?

Closing the loop on my own question.

I went to a lower dose rather than a longer interval on the strength of the trough argument in this thread, and the difference in how even it feels is obvious.