[Meta] the SURPASS rule is doing its job and people should stop complaining
the SURPASS rule is doing its job and people should stop complaining, and here is what changes in practice if it goes ahead.
SURMOUNT-1 ran 72 weeks with the top arm around 21% mean body weight change. SURPASS is the diabetes programme and reports glycaemic endpoints, so quoting the two interchangeably is a category error.
Research-use-only material is not approved for human use. Anything in this thread about how a research vial "should" titrate is a discussion about chemistry, not a plan.
Vials and pens carry the same molecule; what differs is fill volume, device tolerance and whether you are doing your own arithmetic. Neither is inherently more accurate.
Ask me anything specific. Anything general I will probably get wrong.
best — the order this archive was captured in
The four-week interval in the label is a minimum. Nothing about the pharmacology requires you to step on schedule, and the trials stepped on a calendar because trials have to.
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pens and vials are the same molecule, the price is the difference
I would separate the two claims. That the GIP arm exists is uncontroversial; that it explains your nausea pattern is a guess.
Small fix: SURMOUNT is the obesity programme, SURPASS is the type-2 programme. They are different endpoints and the numbers do not transfer.
The distribution matters more than the mean. In the trial population the interquartile spread was wide enough that two honest people can have completely different runs on the same arm.
Trial identifiers corrected in the title. SURMOUNT and SURPASS are different programmes.
switching from sema is not a dose conversion, there is no clean equivalence
Did you come to this from sema, and if so how long was the gap?
Pen or vial? The step sizes available differ and it changes this answer.
Pen or vial?
Not sure about this bit. The GIP arm being real does not tell you that it is what caused your particular week.
2.5 is the starter dose and it is not meant to be the dose that works
Are you comparing yourself with the trial mean or with the people who post the most?
the constipation profile is genuinely gentler than people expect coming from sema
6kg over 21 weeks, never went past 10mg, and fatigue stayed mild the whole way. Posting because the loud threads are all 15mg.
6kg over 21 weeks, never went past 10mg, and fatigue stayed mild the whole way.
hub_ops is right that the two molecules are not interchangeable. There is no published conversion and the ones circulating are invented.
dual agonist, so the GIP arm is doing something the sema threads will not tell you about
Cosigning the four-week thing. It is a minimum interval, and treating it as a schedule to keep up with is how people end up miserable at 12.5.
Same experience with the appetite effect being flatter across the week rather than front-loaded.
Sulphur burps for the first eight days after each step, then nothing. Predictable enough that I planned my week around it.
zepbound and mounjaro are the same compound with different labels
Weekly dosing again, half-life in the same neighbourhood as sema, so a step change takes about a month to reach steady state. Judging a new step at day five is judging noise.
the appetite effect is blunter than sema, in a good way, most weeks
the appetite effect is blunter than sema, in a good way, most weeks
Agreed, with one qualifier: that is the mean of the top arm and the spread around it was enormous.
the four-week step schedule is the label, not folklore
It is a dual GIP and GLP-1 receptor agonist, and the GIP arm is the part that has no equivalent in the semaglutide threads. That is why the side-effect profile reads differently rather than just milder.
SURMOUNT-1 landed around 21% at 72 weeks on the top arm
The 21% figure is a 72-week mean on the highest arm. Quoting it as what someone should expect by week 39 is not a fair reading.
Disagree with the conversion table. There is no validated equivalence between the two molecules and posting one as though there is does real damage.
The step schedule question, answered properly, because it comes up weekly.
The label sets a minimum interval of four weeks between increases. That is a floor on how fast you may go, and it exists because tolerability, not efficacy, is what limits most people. There is nothing in the pharmacology that says you must increase at four weeks, or at eight, or ever.
What decides it in practice is whether the effect you want is still there. If appetite is quiet and the trend is going the right way, the dose is doing its job. If both have genuinely gone flat for six weeks or more, that is a conversation worth having with someone who knows your history.
- 1The four-week interval in the label is a minimum. Nothing about the…17 comments in this branch · started by u/ignacio_vanhecke
- 2Same experience with the appetite effect being flatter across the week…7 comments in this branch · started by u/certified_reference