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ForumsMASH / Liver DiseaseLiver biopsy changes on semaglutide — need advice Page 2

Liver biopsy changes on semaglutide — need advice

mike.trainer_LA Mon, Jun 23, 2025 at 2:09 AM 14 replies 1,362 viewsPage 2 of 3
DataDave
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Jun 23, 2025 at 9:05 AM#6

Adding the numbers, since they settle part of this. For anyone assembling their own picture: Tmax is one to three days, terminal half-life about 165 to 170 hours, steady state at four to five weeks, and subcutaneous bioavailability near 89%. Those four numbers explain most of the questions people ask about timing.

28 23VendorMark, COA_Karl, MikeFit_NJ and 25 others
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Dr.NephBHM_UK
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Jun 23, 2025 at 11:48 AM#7

One thing that is still open after andrew_nyc’s answer:

Whether anyone has held at a sub-maximal dose long term and kept the result, or whether the maintenance data only exists at 2.4mg?

27 22EndoResFellow, PharmacoVig_BOS, SurmountFan_IN and 24 others
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EndoResFellow
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Jun 23, 2025 at 2:31 PM#8
DataDave said:
For anyone assembling their own picture: Tmax is one to three days, terminal half-life about 165 to 170 hours, steady state at four to five weeks, and…

There is a second half to this that has not been said yet. 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.

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

26 21paul_denver, TinaHashiRN, robert_kc and 23 others
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mike.trainer_LA
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Jun 23, 2025 at 5:14 PM#9

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

Six weeks on from posting: I stopped reading the weekly number and started reading a four-week average, and the "stall" I opened this thread about was a 1.8kg loss I could not see.

25 20LeilaHI, marcus_mpls, DeniseRN_TPA and 22 others
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wendy_avl
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Jun 24, 2025 at 6:16 AM#10
EndoResFellow said:
The mechanism that matters here is not stomach emptying, it is central.

EndoResFellow has the substance of this right. The condition it depends on is worth stating. Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak. People who dose late are not losing a peak, they are letting the trough fall, and the appetite effect tracks the trough.

31 4RickReta_CO, PharmHunterJen, TomTeleRx and 28 others
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