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Evidence-based GLP-1 & peptide discussion since 2023
ForumsPublic SquareCan someone explain this to me like I am five? — anyone have experience? Page 2

Can someone explain this to me like I am five? — anyone have experience?

SteveThurs Thu, Dec 5, 2024 at 10:48 PM 7 replies 1,657 viewsPage 2 of 2
Dr.PeteFamMed
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Dec 7, 2024 at 12:26 AM#6
LibrarianMeg said:
Relative and absolute effects need reading together.

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them. The results probably generalise, and "probably" should be stated as an assumption rather than dropped.

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raj_cambridge
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Cambridge, MA
Dec 7, 2024 at 10:40 AM#7
SteveThurs said:
My own curve sits about four points below the published mean and I spent two months assuming that meant something was wrong with me or with my…

Bayesian meta-analysis perspective on the trial evidence: traditional frequentist meta-analyses report point estimates and confidence intervals. Bayesian approaches provide probability distributions that are more intuitive for clinical decision-making.

For example: "There is a 98.5% probability that semaglutide 2.4mg produces >10% weight loss vs placebo" is more actionable than "RR 3.4, 95% CI 2.8-4.1, p<0.001."

The the trial evidence evidence is strong under both frameworks, but Bayesian analysis better communicates the degree of certainty for individual patient counseling.

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Dr.ReproEndo
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Dec 7, 2024 at 8:54 PM#8
Dr.PeteFamMed said:
I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them.

Propensity score matching studies and the trial evidence: when RCTs aren't available for a specific question, propensity score-matched observational studies can provide useful evidence.

A recent PSM study of 25,000 GLP-1 users vs matched controls showed reduced heart failure hospitalization (HR 0.74) over 5 years of follow-up[1].

These results complement the RCT data and suggest the benefits translate to real-world populations.

References:
[1] Registry-based cohort study, pre-print 2024.
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BrianDallas92
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Dec 8, 2024 at 7:08 AM#9

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

Was that from a primary source or from a summary of one?

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SteveThurs
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Dec 10, 2024 at 8:16 AM#10

OP back with an update, since a thread like this is useless without one.

Update — my curve sits below the published mean and the explanation is that the trial arm had support I do not have. That was reassuring rather than otherwise.

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