DebRD_ATL said:

Extending the interval and reducing the dose are pharmacologically different.

The regain framing needs pushing back on. Two thirds regained means one third did not, and the trial provided no ongoing support to either group. Treating regain as pharmacologically inevitable is as unsupported as treating maintenance as automatic.

Happy to go further on any of that.

AttorneyGrant said:

Planning the end of this rather than the middle of it, which nobody around me seems to want to talk about while it is still going well.

STEP 5 long-term data on maintenance dosing: the 104-week (2-year) extension showed sustained weight loss of -15.2% with continued semaglutide vs weight regain in the discontinuation group[1].

Key insight: weight loss continued to accrue between weeks 68 and 104 in many patients, suggesting the nadir may not occur until year 2+. The 68-week primary endpoint in most trials may underestimate maximal efficacy.

This supports long-term, open-ended treatment rather than fixed-duration "courses" of therapy.

Dr.ObesityMed said:

The regain framing needs pushing back on.

Pregnancy after maintenance dosing weight loss: stopped GLP-1 medication 4 months before TTC as recommended. Was terrified of regaining weight during pregnancy.

Worked closely with my OB and MFM. Gained 28 lbs during pregnancy (within recommended range). Baby is healthy. The metabolic improvements from pre-pregnancy weight loss gave both of us a healthier pregnancy.

If you're planning pregnancy, discuss the medication discontinuation timeline with your OB. GLP-1 agonists are NOT safe during pregnancy.

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

Whether extending the interval works as well as reducing the dose, since they are not the same intervention pharmacologically?

Closing the loop on my own question.

I went to a lower dose rather than a longer interval on the strength of the trough argument in this thread, and the difference in how even it feels is obvious.