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how much of what we believe about ACHIEVE actually comes from ATTAIN threads

Paper

how much of what we believe about ACHIEVE actually comes from ATTAIN threads. I would rather ask a basic question now than get this wrong quietly for two months.

Because it is not a peptide, it is not subject to the same degradation pathways, does not require the absorption enhancers used for oral peptides, and can be formulated as a conventional tablet.

Oral semaglutide is a peptide co-formulated with an absorption enhancer and carries food and water timing requirements. A small molecule does not have that constraint, which is the practical distinction.

Daily dosing gives a very different exposure profile from a weekly injectable: peaks and troughs within each day rather than a smoothed weekly curve.

If two or three other people have done the same thing we might actually learn something. Alone it is an anecdote.

2,054 up / 2,136 down50% upvoted15 commentsid x4h3m12 Jan 2025

15 comments

15 in this archive, depth 5

best — the order this archive was captured in

u/trialwatch_theotrial nerd8 points·1 year ago

The analytical point, which this board keeps getting wrong by importing habits from the peptide side.

For a peptide, purity is typically reported as area percent by HPLC with identity by mass spectrometry, and the impurity classes are things like deletion and oxidation products. For a small molecule the relevant impurities are synthetic intermediates, degradants and residual solvents, and identity is established differently.

So the certificate you would want looks different, the questions to ask are different, and a "purity" figure quoted here is not comparable to one quoted on the peptide boards. Anybody posting a result should say what method produced it, which is good practice everywhere and essential here.

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u/trialwatch_theoMOD5 points·1 year ago

Retitled to name the programme. It is what makes these threads findable in a year.

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u/search_before_postOP3 points·1 year ago

no food and water restrictions is the practical difference people care about

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u/search_before_postOP-17 points·1 year ago

The analytical point, which this board keeps getting wrong by importing habits from the peptide side.

Agreed, and it is why the oral peptide comparison keeps misleading people.

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u/search_before_postOP1 point·1 year ago

Correction: that is the oral peptide product, which is a different thing entirely. This one is a small molecule.

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[removed]6 points·1 year ago

[removed by moderator]

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u/paloma_stanescu5 points·1 year ago

The no-timing-restriction thing is the part I would care about most in practice, and it barely gets mentioned here.

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u/trialwatch_theotrial nerd0 points·1 year ago

Is that from the publication or the press release?

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u/mateusz_mensah1 point·1 year ago

Disagree. You are comparing doses across a small molecule and a peptide, which is not a comparison of anything.

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u/greta_nilsen5 points·1 year ago

small molecule, not a peptide, and that changes everything about it

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u/paloma_stanescu7 points·1 year ago

do not assume reconstitution intuitions apply, there is nothing to reconstitute

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u/piotr_bruun0 points·1 year ago

Milligram-for-milligram comparison with an injectable peptide is not meaningful and I should not have made it.

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u/viktor_laurent4 points·1 year ago

Small fix — the two programme names got swapped upthread and it changes which population the figure came from.

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u/discount_math_dm2 points·1 year ago

Agreed that phase 3 is where the comparison becomes fair. Everything before it is inference.

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u/joaquin_trevino1 point·1 year ago

Not convinced. Oral semaglutide is a peptide formulated with an absorption enhancer; the comparison you are making does not hold.

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The small-molecule oral: why a non-peptide agonist escapes the absorption problems of oral semaglutide, what the ATTAIN and ACHIEVE readouts showed, and what a pill with no refrigeration requirement would do to the entire supply conversation this site is built around.

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