Topic summary

Where the four-week escalation interval comes from, and what it is not

Practice › Dosing & titration missed dose semaglutide tirzepatide titration dose reduction Solved

This is a generated summary. It shows the 9 most-liked posts from a topic of 61, 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.

w.verhoevenTL2 Solution20 May 2024#3

Norrington, post #2: Reading this four-week escalation interval thread as someone who came in with a fixed view: the third and seventh replies moved me and the confident ones did not. Go to post

On four-week escalation interval, 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.

7 likes in reply to #2 2.2y

i.ilungaTL227 May 2024#7

That is a cleaner way of putting what I was circling around.

27 likes 2.2y

k.radichTL21 Jun 2024 · edited#11

Where I have landed on four-week escalation interval, having got it wrong once in public: the direction is clear, the magnitude is not, and anyone quoting a precise magnitude has borrowed it from somewhere that did not measure it.

28 likes 2.2y

buffer_reviewTL3Regular13 Jun 2024#20

Narrowing post #19, because the general version has more than one answer.

I disagree with the framing of four-week escalation interval 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.

27 likes 2.1y

c.vermeulenTL216 Jun 2024 · edited#22

s.grigorescu, post #6: One caution on four-week escalation interval: everything above assumes the underlying documentation is what it claims to be. That assumption is doing real work and is rarely stated. Go to post

Concentration and dose get conflated constantly in this subcategory. Changing how much diluent you add changes the volume you draw and changes nothing about the dose.

23 likes in reply to #6 2.1y

s.solbergTL221 Jun 2024#27

Post #24 answers the question as asked. The question underneath it is different.

Two questions I would want answered before drawing anything from the four-week escalation interval data above: how were the cases selected, and what happened to the ones that dropped out.

32 likes 2.1y

customs_ledgerTL3Regular26 Jun 2024#31

An honest declaration on four-week escalation interval: I have a prior here and it is strong enough that you should weight what I say downward. Stating it rather than hiding it.

21 likes 2.1y

dr_seongTL3Physician8 Jul 2024#42

Worth separating two things that post #40 runs together.

There is no published evidence about slower escalation because nobody studied it. That means the trials support not going faster and are silent on going slower, which is a different claim from "slower is fine".

28 likes 2.1y

s.radichTL223 Jul 2024#57

v.salgado, post #24: Everything in post #22 holds. The case it does not cover is the one I have. 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… Go to post

The reason four-week escalation interval keeps being re-asked is that the answer is conditional and people quote it without the condition. It is not that the answer is unknown.

27 likes in reply to #24 2y

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This topic was referenced in

Why "dose equivalence" between different incretin analogues is a weak conceptPractice › Dosing & titration · 133 replies
When a dose reduction is the correct response to a side effectPractice › Dosing & titration · 42 replies

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