What I want from this SURMOUNT-OSA thread is the list of things that would need to be true for the claim to hold. If we can write that list, we can check it.
Posting this under the heading it deserves: Journal club: SURMOUNT-OSA and a hard endpoint in a soft field Everything below is what sits behind that.
Collecting what is known about SURMOUNT-OSA in one place, because it is currently spread across a category, two tag pages and a thread that is hard to find.
This is a summary rather than new work, and I have attributed each part to where I found it.
The version of SURMOUNT-OSA that I was taught turned out to be a teaching simplification. Useful, and not true in the way I had assumed it was.
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.
Written quickly, so the reasoning may be tighter than the wording.
Adding the measurement that post #4 says would settle it.
SURMOUNT-OSA is a good example of a question where the honest answer is boring and the interesting answers are unsupported. I would go with boring.
Nothing to add, except that this is the answer I would give if asked.
Careful with the language on SURMOUNT-OSA. "Not detected" and "not present" are different findings and the first is a statement about the method.
Worth separating two things that post #9 runs together.
SURMOUNT-OSA sits at the boundary between what this community can usefully discuss and what it cannot, and I think it falls on the discussable side, narrowly.
Adding a data point of agreement rather than a data point.
Taking post #13 at face value and following it one step further.
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.
The confident version of this sentence would be wrong, so here is the hedged one.
Adding a null result on SURMOUNT-OSA. I looked, carefully, and found nothing, and null results deserve posting precisely because they never are.
Sessions on negative or null results are consistently the most instructive and the hardest to get anyone to attend.
The practical version of SURMOUNT-OSA is three sentences long. The rigorous version is three pages and reaches the same conclusion with the conditions attached.
Adding the measurement that post #18 says would settle it.
On SURMOUNT-OSA, I would rather understate and be corrected upward than overstate and be quoted. That is a house style here and it is a good one.
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.
If that reads as pedantic, it is, and it has saved me twice.
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.
On reflection I would soften that slightly.
Picking up post #23: that is the part I would want checked first.
Adding a small correction to the SURMOUNT-OSA summary above rather than a disagreement with it. The substance holds; one of the figures is out by a factor that matters.
On post #24 — agreed on the reasoning, with one qualification.
The thing about SURMOUNT-OSA that took me longest to accept is that a plausible mechanism is not evidence of an effect. It is a reason to look, not a result.
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.
Posting my SURMOUNT-OSA numbers with the method attached so they can be discounted properly. Uncontrolled, unblinded, and collected by someone who wanted a particular answer.