Topic summary

SURMOUNT-4 and what withdrawal data does and does not tell an individual — one year on

Compounds › Tirzepatide SURMOUNT programme randomised trial tirzepatide SURPASS programme effect size Solved Closed

This is a generated summary. It shows the 9 most-liked posts from a topic of 137, in their original order, with the accepted answer included where one exists. It is a reading aid and it will miss nuance — the full topic is the record.

m.mwangiTL218 Oct 2025#3

The opening post answers the question as asked. The question underneath it is different.

I would call the community position on SURMOUNT-4 likely rather than established, and I would be comfortable defending that hedge.

27 likes 9mo

m.dalgaardTL3Regular Solution18 Oct 2025#6

Worth separating two things that post #2 runs together.

Comparisons between the tirzepatide and semaglutide programmes across trials rather than within one are weak. Different populations, different durations, different baseline characteristics; the only fair comparison is a head-to-head one.

13 likes 9mo

np_gilmoreTL3Nurse practitioner19 Oct 2025#13

On post #9 — agreed on the reasoning, with one qualification.

The five maintenance doses in the tirzepatide programme give a genuine dose-response curve, which is unusual. Most trials in this space compare one or two doses against placebo and cannot say anything about the shape of the relationship.

28 likes 9mo

a.salcedoTL3Regular20 Oct 2025#31

NLoughran, post #27: SURMOUNT-4 used a randomised withdrawal design: everyone titrated, then those on maintenance were randomised to continue or placebo. Continuation maintained effect; withdrawal was followed by regain. The finding is robust but it says nothing about a lower effective maintenance dose, because that was not studied. If anyone has run this… Go to post

I read post #27 twice before replying, because I had assumed the opposite.

I disagree with the framing of SURMOUNT-4 above, and I think it is a substantive disagreement rather than a terminological one. Setting out why, so it can be checked.

The reasoning depends on an assumption that is doing a lot of work and is never stated. If the assumption holds, the conclusion follows. I do not think it holds generally.

33 likes in reply to #27 9mo

m.ndiayeTL220 Oct 2025#40

KAndersson, post #19: Post #17 put the caveat in the right place and I want to underline it. Reporting rather than recommending, on SURMOUNT-4. What happened is above. Whether it should have is a different question and not one I am qualified to answer. Go to post

The arithmetic in post #39 is right; the assumption feeding it is the part to check.

The 2.5 mg starting dose is a tolerance step and not a therapeutic one. Judging efficacy at that dose is the single commonest reasoning error in this subcategory.

The rule of thumb is fine; the edge cases are where it earns its keep.

32 likes in reply to #19 9mo

IHollingworthTL2Member21 Oct 2025#48

Answering the question post #46 raises rather than the one it answers.

I keep a log for SURMOUNT-4 specifically because my memory of it turned out to be systematically wrong in one direction. Six weeks of notes cost nothing and settled it.

29 likes 9mo

j.palaciosTL221 Oct 2025#56

JFitzgibbon, post #37: I changed my mind about SURMOUNT-4 after someone here asked me for the source and I could not produce one. That is worth saying out loud because it is the ordinary way it happens. Go to post

Understood, and I withdraw the assumption I opened with.

27 likes in reply to #37 9mo

g.ibarraTL223 Oct 2025#94

Gastrointestinal effects were comparable in character to the GLP-1 monoagonists across the programme. Individual reports here vary in both directions, which is what you would expect from a between-person difference rather than a between-drug one.

28 likes 9mo

GEldridgeTL3Regular24 Oct 2025#108

Two people in this thread mean different things by SURMOUNT-4 and are disagreeing about the definition while believing they are disagreeing about the facts. Worth pausing to define it.

30 likes 9mo

Read the full topic (137 posts)

This topic was referenced in

Tirzepatide in obstructive sleep apnoea: reading SURMOUNT-OSACompounds › Tirzepatide · 8 replies

This topic was closed 120 days after the last reply. Closing is automatic for quiet topics so that a settled answer does not collect new questions underneath it. If you have a follow-up, open a new topic and link back to this one — that keeps both readable and gives your question its own title.

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