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ForumsCardiovascular OutcomesSTEP-HFpEF: semaglutide in heart failure with preserved EF — need advice Page 2

STEP-HFpEF: semaglutide in heart failure with preserved EF — need advice

pam_stl Thu, Apr 23, 2026 at 6:17 PM 12 replies 546 viewsPage 2 of 3
Dr.PathRoch
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Apr 23, 2026 at 7:44 PM#6

The figures, for anyone assembling their own picture. Worth knowing that the injection site changes very little. Abdomen, thigh and upper arm are bioequivalent for semaglutide, so a site change is not a plausible explanation for a bad week.

32 2MikeFit_NJ, InsuranceTom, WendyG_ATL and 29 others
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CryptoCarl
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Apr 23, 2026 at 8:17 PM#7

A narrower follow-up, since the general answer is now clear:

How much of the between-person variation is pharmacokinetic and how much is just adherence measured badly?

Last edited: Apr 24, 2026 at 12:17 AM
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lisa_labSD
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San Diego, CA
Apr 23, 2026 at 8:50 PM#8
Dr.PathRoch said:
Worth knowing that the injection site changes very little.

Coming at Dr.PathRoch’s question from a different direction. The mechanism that matters here is not stomach emptying, it is central. GLP-1 receptor agonism in the arcuate nucleus stimulates POMC neurons and suppresses AgRP/NPY signalling, which is why the effect is appetite and food salience rather than physical fullness. Delayed gastric emptying largely tachyphylaxes over the first months; the appetite effect does not.

30 0Dr.PulmRoch, maya_sedona, stefan_berlin and 27 others
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pam_stl
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St. Louis, MO
Apr 23, 2026 at 9:23 PM#9

Reporting back.

Update since I posted: I held at 1.7mg for a further twelve weeks and lost another 4kg slowly, which settles it for me. I was escalating because the number was available, not because I had stopped responding.

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NurseLeah_Nash
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Nashville, TN
Apr 24, 2026 at 12:03 AM#10
lisa_labSD said:
The mechanism that matters here is not stomach emptying, it is central.

That holds for the injectable. The oral formulation has different absorption behaviour and the dose numbers are not interchangeable, which is worth saying out loud because people quote them as if they were.

19 19Dr.NateNeph, PharmD_Rodriguez, julia.endo and 16 others
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