Revisiting: Journal club: SURMOUNT-OSA and a hard endpoint in a soft field posts 61–90
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
The honest answer on SURMOUNT-OSA is that it depends, and the useful part is the list of what it depends on. Four items, in rough order of how much they matter.
Most people get the first two right and then argue about the fourth.
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.
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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.
Counterpoint on SURMOUNT-OSA, offered without confidence: the same observation is consistent with a much duller explanation, and nobody has ruled the dull one out.
Building on post #66 rather than restating it.
Since SURMOUNT-OSA keeps coming up, it should probably be a maintained page rather than a recurring thread. I am happy to draft it if someone with more direct experience will review it.
I read post #68 twice before replying, because I had assumed the opposite.
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.
I have left out the parts I could not verify.
Post #68 answers the question as asked. The question underneath it is different.
Summarising the SURMOUNT-OSA thread so far, since it is long and the answer is buried: the first reply has the method, the fourth has the correction to it, and the rest is people agreeing at length.
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.
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.
Adding this to the thread rather than to the wiki, because I am not confident enough for the wiki.
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.
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SURMOUNT-OSA 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.
On SURMOUNT-OSA the community has more anecdote than the confidence in this thread implies, and I include my own contribution in that.
Confirming post #81 from a second method, which matters more than confirming it from a second person.
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.
If it helps: the failure mode here is usually boring rather than dramatic.
Post #81 describes the usual case. This is about the unusual one.
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.
I would keep SURMOUNT-OSA and the decision it usually gets used for separate in this thread. They are related and they are not the same question, and merging them is why the last one went badly.
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I will take the caveat as seriously as the claim, which is the point of putting it there.
SURMOUNT-OSA looks different depending on whether you are reading the primary literature or the summaries of it, and the difference is not in our favour.
On post #86 — agreed on the reasoning, with one qualification.
Sessions on negative or null results are consistently the most instructive and the hardest to get anyone to attend.
Same conclusion as the reply above, reached differently, which is mildly reassuring.
Picking up post #86: that is the part I would want checked first.
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.
That is what I would do. It may not be what is correct.
SURMOUNT-OSA is worth one more sentence than it usually gets, and the sentence is the one about how the number was arrived at.