james_edin said:Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.
Saving this. It is the first explanation that did not require me to already understand it. Printing the relevant bit and taking it with me.
Adding the clinical framing, because it changes how the question reads.
BethLabQueen said:...but the FDA says semaglutide...
Interesting point. I want to add some regulatory nuance: the FDA labeling reflects the specific clinical trial data submitted for approval. Real-world clinical practice often extends beyond the FDA label based on emerging evidence and clinical judgment.
Example: semaglutide was first approved for diabetes (Ozempic), then obesity (Wegovy). The molecule didn't change — our understanding of its applications expanded. Similarly, semaglutide may evolve as more data accumulates.
Dr.GastroMayo said:The dose-response is real but shallow at the top.
I read this differently from Dr.GastroMayo, on substance rather than tone. The trial means are being read too generously in this thread. STEP populations were selected, supported, and titrated by protocol, and the real-world curves are consistently a few points worse. That difference is not noise, it is what happens when you remove the study infrastructure.
Happy to go further on any of that.
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Browse GL BiochemOne concrete data point for the thread. A quick sanity check on any figure quoted here: is it mean or median, is it intention-to-treat or completers, and what was the comparator. Three questions, and they resolve most disagreements in these threads.