Adolescents: a distinct evidence base — one year on posts 61–89
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Worth separating two things that post #59 runs together.
Almost every population discussed here was excluded from the pivotal trials, which means the evidence base is observational at best and absent at worst.
The number people quote for Adolescents is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly uninformative on its own.
Post #64 and I disagree about the size of the effect, not about the direction.
On Adolescents, 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.
Narrowing post #66, because the general version has more than one answer.
Nothing in this subcategory is medical advice and the questions asked here are precisely the ones that need an individual assessment.
Adolescent evidence exists for some compounds in this class and is a separate approval decision with its own trials rather than an extension of the adult data.
Second this, and I would have said it less carefully.
Post #67 put the caveat in the right place and I want to underline it.
The absence of a reported signal in a population that was barely enrolled is not evidence about that population.
The strength of my opinion here exceeds the strength of my evidence.
Building on post #71 rather than restating it.
Reporting rather than recommending, on Adolescents. What happened is above. Whether it should have is a different question and not one I am qualified to answer.
This is the answer, and the reason it is the answer is the more useful part.
Adolescents came up in a thread eighteen months ago and was answered well. I cannot find it, which is itself the problem, so here is the reconstruction.
Collapsed as off-topic by two members at trust level 3 or above
Almost every population discussed here was excluded from the pivotal trials, which means the evidence base is observational at best and absent at worst.
One more thing on Adolescents that took me far too long to see: the two figures people quote are not measuring the same quantity. Once you notice that, the apparent contradiction disappears.
Collapsed as off-topic by two members at trust level 3 or above
Building on post #80 rather than restating it.
Being outside the studied population does not mean a treatment is unsafe. It means the usual evidence is not available and the reasoning has to be explicit.
The honest answer is that it depends, and here is what it depends on.
Post-surgical populations, particularly after procedures affecting the gastrointestinal tract, interact with a delayed-emptying mechanism in ways that need specialist input.
That has held every time I have looked, which is not the same as always.
Reading rather than contributing, but this is the most useful thread I have found on it.
Body weight at the extremes of the studied range affects exposure and the trials rarely reported enough to say by how much.
That holds for the case as described. Change the assumptions and it may not.
Genetic and ancestry-related differences in response are asked about regularly and the published evidence is thin enough that the honest answer is short.
The arithmetic in post #84 is right; the assumption feeding it is the part to check.
Adolescents: a distinct evidence base exists. The compounds are not approved for routine adolescent obesity but are being studied. Adolescent physiology and psychology differ from adults' in ways that matter for this medication class.
I am not the right person to answer the follow-up to this.
Answering the question post #86 raises rather than the one it answers.
Adding a small correction to the Adolescents summary above rather than a disagreement with it. The substance holds; one of the figures is out by a factor that matters.
Careful with the language on Adolescents. "Not detected" and "not present" are different findings and the first is a statement about the method.
This topic was referenced in
- Adolescents: a distinct evidence baseClinical › Special populations · 3 replies
- Athletes in weight-category sports: a different risk calculusClinical › Special populations · 42 replies
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