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[Question] SURMOUNT — what am I missing here

Question Long Haul ×9 Clean Column ×1 Cold Box ×1

SURMOUNT — what am I missing here. If this has been answered properly somewhere, link me and I will delete.

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.

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.

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.

I will update this if the picture changes rather than quietly leaving it up.

4,313 up / 817 down84% upvoted69 commentsid p9308g17 Feb 2025

69 comments

30 in this archive, depth 6

best — the order this archive was captured in

u/ferran_mensah361 points·1 year ago

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.

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[removed]147 points·1 year ago

[removed by moderator]

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u/amara_halonen226 points·1 year ago

Went 10 to 12.5 on the calendar and had the worst fortnight of the whole run. Dropped back to 10 and everything settled.

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u/zaid_balogun156 points·1 year ago

What step are you on and how long have you been there?

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u/blunt_coldbox2981 points·1 year ago

2.5 is the starter dose and it is not meant to be the dose that works

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u/hana_pereira38 points·1 year ago

SURMOUNT-1 landed around 21% at 72 weeks on the top arm

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u/dario_vermeulen-37 points·1 year ago

the appetite effect is blunter than sema, in a good way, most weeks

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u/search_before_postOP16 points·1 year ago

Does food noise follow the day after the shot, or is it spread across the week?

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u/search_before_post4 points·1 year ago

Sulphur burps for the first eight days after each step, then nothing. Predictable enough that I planned my week around it.

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u/curious_panel_only21 points·1 year ago

the trials titrated on a calendar, real people titrate on symptoms

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u/slow_logbook_ftw25 points·1 year ago

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.

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u/piotr_nascimento127 points·1 year ago

Which week did the appetite change actually land for you?

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u/incretin_ivypharmacology63 points·1 year ago

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.

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u/dexa_twice_yearlybody comp21 points·1 year ago

hold the dose that works, the ladder is not a leaderboard

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u/coring_the_stopper5 points·1 year ago

Came off sema and onto tirz with a two-week gap. The first month was flat and I assumed I had made a mistake. Month two it moved.

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u/mod_cold_roommod · c/coldchain34 points·1 year ago

Correction to my own post above — I said 10mg and I have been on 2.5mg since the spring. Same argument, wrong number.

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u/amara_halonen186 points·1 year ago

Week 24 was the first time the scale moved after a five-week stall. I changed nothing in that window.

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u/blunt_coldbox29172 points·1 year ago

2.5mg is a four-week starting dose, not a maintenance dose. Worth being precise since people search these threads.

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u/swirl_dont_shakereconstitution91 points·1 year ago

Agree. The GIP component is the interesting half and it barely gets discussed outside c/glp1science.

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u/rania_diallo45 points·1 year ago

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.

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u/incretin_ivypharmacology24 points·1 year ago·edited

That percentage is body weight change, not body fat. Different measurement, and the distinction gets lost every time.

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u/search_before_postOP9 points·1 year ago

18kg over 60 weeks, never went past 10mg, and injection-site soreness stayed mild the whole way. Posting because the loud threads are all 15mg.

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u/search_before_post156 points·1 year ago

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.

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u/adnan_nascimento55 points·1 year ago

Not sure that follows. You went up a step and changed your training in the same fortnight.

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u/line_petrov83 points·1 year ago

pens and vials are the same molecule, the price is the difference

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u/ingrid_correia18 points·1 year ago

the nausea profile is genuinely gentler than people expect coming from sema

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About c/tirzepatide

Tirzepatide-specific discussion: the dual-agonist pharmacology, the 2.5 → 15mg ladder, the appetite profile people describe as different from semaglutide, and the SURMOUNT/SURPASS trial programme. Comparisons with semaglutide are welcome as long as they are specific about dose equivalence being unknown.

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