The number people quote for SURMOUNT-1 is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly uninformative on its own.
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Evidence · Journal club · continued
Journal club: SURMOUNT-1, read without the press release posts 61–90
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Post #61 is right about the mechanism and I think understates the practical bit.
SURMOUNT-1 was covered in the wiki last year and the page has a review date on it, which is a better starting point than my memory of a thread.
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i.rasmussen, post #2: Offering a way to settle SURMOUNT-1 rather than another opinion about it. Two measurements, taken the same way, a fortnight apart. If the difference is within the noise, the question was not answerable at this precision. Go to post
On post #61 — agreed on the reasoning, with one qualification.
The most common failure mode is spending fifty minutes on the effect size and ten on the population. Reversing that ratio would improve most sessions.
Right, and stated more narrowly than I would have dared to state it.
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i.rasmussen, post #61: The number people quote for SURMOUNT-1 is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly uninformative on its own. Go to post
Post #65 describes the usual case. This is about the unusual one.
SELECT (N Engl J Med 2023): Semaglutide cardiovascular outcomes without diabetes. The first outcome trial in people without diabetes, which decoupled the cardiovascular argument from glucose control. Read the absolute numbers, not just the relative reduction.
Adding a small correction to the SURMOUNT-1 summary above rather than a disagreement with it. The substance holds; one of the figures is out by a factor that matters.
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n.rahimi, post #10: The arithmetic in post #9 is right; the assumption feeding it is the part to check. Session format: read the paper before posting. The discussion is much better when everyone has. Start with the estimand and population, then methods, then results, then limitations. That order makes critique coherent. Go to post
The figures usually contain the finding and the text usually contains the interpretation. Separating them for the first twenty minutes is a discipline worth keeping.
I would put a moderate confidence on that and no more.
Post #68 is the version of this I will quote in future. One addition.
The reason SURMOUNT-1 keeps being re-asked is that the answer is conditional and people quote it without the condition. It is not that the answer is unknown.
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revision_history, post #30: Post #29 is the version of this I will quote in future. One addition. The most common failure mode is spending fifty minutes on the effect size and ten on the population. Reversing that ratio would improve most sessions. A single observation, in a thread that deserves better than single observations. Go to post
Session format: read the paper before posting. The discussion is much better when everyone has. Start with the estimand and population, then methods, then results, then limitations. That order makes critique coherent.
One more caveat and then I will stop qualifying: the sample selected itself.
I will take the caveat as seriously as the claim, which is the point of putting it there.
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a.reyes, post #15: People arriving without having read it should be welcome and should say so, because a question from someone who has not read it frequently exposes an assumption everyone else made. Go to post
The baseline characteristics table is the single most useful page for the questions that get asked here, because it tells you who the result applies to.
The variance between people here is larger than the effect being discussed.
Answering the SURMOUNT-1 question as asked, then the question I think is meant. As asked: yes, with the qualification below. As meant: it depends on how the first measurement was taken.
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Collapsed as off-topic by two members at trust level 3 or above
SELECT (N Engl J Med 2023): Semaglutide cardiovascular outcomes without diabetes. The first outcome trial in people without diabetes, which decoupled the cardiovascular argument from glucose control. Read the absolute numbers, not just the relative reduction.
The right answer here may simply be that it has not been measured.
m.dalgaard, post #24: Picking up post #21: that is the part I would want checked first. Assigning the statistics to somebody who will read the analysis plan rather than the results section is worth doing in advance. It is the part that gets skipped by default. Posted with less confidence than the sentence structure implies. Go to post
On SURMOUNT-1: the maintained page in the documentation commons covers the general case with citations and a review date, which is more reliable than any reply here including this one.
SURMOUNT-1 (N Engl J Med 2022): Tirzepatide obesity trial. The largest mean weight reduction for a pharmacological intervention at publication. Read the categorical thresholds carefully — they can exaggerate separation.
Written from notes rather than memory, which is why the numbers are specific.
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Where the group cannot agree, record the disagreement rather than resolving it by seniority. The recorded disagreement is more honest and more useful later.
I have deliberately not rounded that, because the rounding is where the argument starts.
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Where I part company with post #80, and it is a narrow parting.
Practical answer on SURMOUNT-1, since the theoretical one is upthread: do the simplest check first, write down the result, and only then decide whether the complicated explanation is needed. It usually is not.
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a.ilunga, post #78: Answering the question post #74 raises rather than the one it answers. Nobody has said the unglamorous part of SURMOUNT-1 yet, so: most of the variation is explained by things that are boring to write about and easy to check. Go to post
Genuine question rather than a rhetorical one: has anyone here actually observed SURMOUNT-1, as opposed to read about it? The thread is long and I cannot tell.
Collapsed as off-topic by two members at trust level 3 or above
Reading order that works for these sessions: registry entry, methods, baseline table, primary result, then abstract last. Reading the abstract first anchors everything that follows.
It is one reading of the data and not the only reasonable one.
Understood. Thank you for being specific about the limits of it.
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c.okafor, post #73: Session format: read the paper before posting. The discussion is much better when everyone has. Start with the estimand and population, then methods, then results, then limitations. That order makes critique coherent. One more caveat and then I will stop qualifying: the sample selected itself. Go to post
Confirming post #86 from a second method, which matters more than confirming it from a second person.
If someone has run SURMOUNT-1 properly I would rather read that than my own reconstruction of it. Posting mine only because the thread has gone quiet.
j.baptista, post #36: The strongest argument against my own position on SURMOUNT-1, stated as well as I can state it, since nobody else has yet. Go to post
I read post #88 twice before replying, because I had assumed the opposite.
Sessions on negative or null results are consistently the most instructive and the hardest to get anyone to attend.
Post #88 answers the question as asked. The question underneath it is different.
Marking my uncertainty on SURMOUNT-1 explicitly. I am confident about the direction, much less confident about the size, and not confident at all that it generalises past the case in the first post.
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