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Evidence · Journal club

Journal club: how we handle discontinuation in obesity trials

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Solved by customs_ledger in post #2
I had written a reply contradicting the opening post and deleted it. Here is what survived. STEP 1 (N Engl J Med 2021): The pivotal obesity trial for semaglutide and the reference point for most subsequent comparison. Mean weight reduction was substantially larger than anything previously achieved pharmacologically.

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l.solbergTL230 Jun 2025#1

On the subject in the title: Journal club: how we handle discontinuation in obesity trials Working notes rather than a conclusion.

Session topic: PIONEER 6 (N Engl J Med, 2019). Please read it before posting; the discussion is much better when everyone has.

The question I would like us to start with is what the trial set out to estimate, rather than what it found. Once that is on the table we can talk about whether the design could have answered it, and only then about the numbers.

Specific things I would like covered: the population and how far it generalises, how discontinuation was handled, whether the comparator was a fair one, and what the absolute rather than relative effect looks like.

I will summarise at the end and the summary will feed the relevant digest page.

15 likes 13mo
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customs_ledgerTL3Regular Solution19 Jul 2025#2

I had written a reply contradicting the opening post and deleted it. Here is what survived.

STEP 1 (N Engl J Med 2021): The pivotal obesity trial for semaglutide and the reference point for most subsequent comparison. Mean weight reduction was substantially larger than anything previously achieved pharmacologically.

19 likes 12mo
PM
p.mwangiTL22 Aug 2025 · edited#3
customs_ledger, post #2: I had written a reply contradicting the opening post and deleted it. Here is what survived. STEP 1 (N Engl J Med 2021): The pivotal obesity trial for semaglutide and the reference point for most subsequent comparison. Mean weight reduction was substantially larger than anything previously achieved pharmacologically. Go to post

SURMOUNT-OSA (N Engl J Med 2024): Tirzepatide in obstructive sleep apnoea, using an objective physiological endpoint. Notable because soft endpoints are avoided. Two parallel trials addressed the confounder directly.

Someone will know this better than I do and I hope they say so.

0 likes in reply to #2 12mo
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