Revisiting: Holding a dose indefinitely: is there a documented downside?

The question in the title: Revisiting: Holding a dose indefinitely: is there a documented downside? I will give what I have already checked below so nobody repeats it.

I have read the maintained page on this and I still have a gap, so I am asking rather than guessing.

Context: tirzepatide, 4 weeks in, currently at a dose I reached by the standard four-week steps. Everything below is my own record rather than anything a clinician told me.

The specific question is the one in the title. What I have already checked: the labelling summary on the relevant documentation page, the two most-linked topics in this subcategory, and my own notes from the last 9 weeks. What I could not find is whether the answer changes at higher doses or whether it is the same arithmetic throughout.

If the answer is "it depends", I would rather know what it depends on than be given a number.

The maximum studied dose is a fact about the trial and not a ceiling on the molecule. It is also the last point at which anything is known, which is the reason to treat it as one.

Dose equivalence between different incretin analogues is a weak concept. The molecules differ in structure, half-life, receptor selectivity, and in what has been studied clinically. One mg of semaglutide is not equivalent to one mg of something else in any meaningful sense.

The uncertainty is in the assumption, not in the calculation.

I had written a reply contradicting post #19 and deleted it. Here is what survived.

The four-week escalation interval is a convention from the pivotal trials, not a pharmacological constant. The pharmacological argument is that with a week-long half-life, four weeks approaches steady state and you can assess the dose fairly. That is an argument for not going faster. It is not an argument against going slower.

The reasoning is more useful than the number, which is why I have shown it.