[Discussion] the endpoint advice in here is 3 years out of date
the endpoint advice in here is 3 years out of date. It is the sort of thing everyone half-believes and nobody writes down.
3 years. Those are measured, not estimated, and not rounded up in my favour.
Argued for a week about a result and then read the limitations section, which conceded most of my opponent’s point.
How to read one of these papers in fifteen minutes, in the order that actually helps.
Start with the registered protocol and check the primary endpoint against what is reported. Then the methods: who was included, what the comparator was, how long the randomised phase ran. Then the discontinuation numbers, which are a tolerability result and are usually in a supplementary table.
Only then the efficacy figure, and read the interval rather than the point estimate. Finish with the limitations section, which is where the authors say what they actually think.
Fifteen minutes, and you will know more than any thread summarising it.
That is everything I have. The rest is opinion and I have tried to keep it out.
best — the order this archive was captured in
Discontinuation rates are a tolerability result. A trial with a strong efficacy number and heavy discontinuation is telling you two things and people only quote one.
The registered protocol is public. Comparing the registered primary endpoint with the reported one is a two-minute check and it is how outcome switching gets caught.
Discontinuation rates are a tolerability result.
Adding the check nobody runs — the registered protocol is public and takes two minutes to compare.
SELECT was cardiovascular outcomes, not weight
Disagree — that figure is from the diabetes programme and you are quoting it as an obesity endpoint.
SURPASS is the diabetes programme and reports glycaemic endpoints
registry entry, protocol, publication — three different documents
FLOW was kidney outcomes and it is the one nobody quotes
read the endpoint before you read the headline
Push back: an open-label extension tells you about the people who stayed. That is a different question.
How long was the randomised phase before any extension?
That is a relative risk reduction. Quoting it without the absolute numbers overstates the case considerably.
open-label extensions are not the same evidence as the randomised phase
Press-release posts get their own flair here. Nothing wrong with them, they are just a different kind of claim.
discontinuation rate is a result, not a footnote
Absolute or relative risk reduction?
Is that intention-to-treat or completers?
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Yes — the interval is the finding. A point estimate with a wide interval is a hypothesis in a nice font.
Same. A press release is a claim about a result; the publication is the result.
phase 2 finds a dose, phase 3 measures the effect
Careful with that mean. The distribution around it was wide enough that it describes very few individual participants.
Right — trial participants get structured support. Comparing yourself to a trial mean is comparing across two different interventions.
Started keeping the trial identifiers straight in a note file because I kept mixing up two programmes in the same sentence.
Not convinced. Cross-trial comparison between two programmes with different populations and designs is not a comparison.
Small fix — that was the cardiovascular outcomes trial, so weight was a secondary endpoint and the population was different.
Compared myself to a trial mean for about six months before realising the trial arm had dietitian contact every fortnight.
Agreed on comparators. "Superior" means nothing until you know superior to what and at what dose.
STEP is semaglutide obesity, SURMOUNT is tirzepatide obesity, they are not interchangeable
Relative risk reduction without the baseline rate is uninterpretable. A large relative reduction on a small absolute risk is a small absolute benefit.
- 1Push back: an open-label extension tells you about the people who stayed.…11 comments in this branch · started by u/nightowl_injector
- 2phase 2 finds a dose, phase 3 measures the effect10 comments in this branch · started by u/injection_site_iris