Taking the question as asked, rather than the general version of it. The gap between trial results and real-world results is consistent and it is not fraud. Trial participants get titration by protocol, scheduled contact, free drug and dietetic support; removing that infrastructure costs a few percentage points every time it has been measured. When your own curve sits below the published mean, that is the likeliest explanation before anything about you or your material.

Ask again with the specifics and you will get a better answer than this one.

amsterdam_pete said:

The gap between trial results and real-world results is consistent and it is not fraud.

Agreed, and subgroup analyses deserve particular suspicion. With enough subgroups something is significant by chance, and pre-registered subgroups are a different animal from ones found afterwards.

mike_mod said:

Looking at the combination against simply going higher on a single agent, and the price difference is doing more work in my thinking than the…

Same experience, arrived at from the opposite direction. Posting only so the count is not one.

Adding the clinical framing, because it changes how the question reads. Take it one variable at a time. Almost every unanswerable question in these threads is unanswerable because three things changed in the same fortnight, and no amount of subsequent argument can untangle them after the fact.