reading SURMOUNT threads from 2024 and half of it aged badly
The title is the argument: reading SURMOUNT threads from 2024 and half of it aged badly. Here is the rest of it.
Discontinuation rates are a tolerability result. A trial with a strong efficacy number and heavy discontinuation is telling you two things and people only quote one.
The registered protocol is public. Comparing the registered primary endpoint with the reported one is a two-minute check and it is how outcome switching gets caught.
Relative risk reduction without the baseline rate is uninterpretable. A large relative reduction on a small absolute risk is a small absolute benefit.
If somebody has the same thing measured a different way, post it next to mine and we will see whether they agree.
best — the order this archive was captured in
Cardiovascular outcome trials are powered for events, not for weight, and are typically run in a different population with different inclusion criteria. Reading a weight number out of one is reading a secondary endpoint.
How to read one of these papers in fifteen minutes, in the order that actually helps.
Start with the registered protocol and check the primary endpoint against what is reported. Then the methods: who was included, what the comparator was, how long the randomised phase ran. Then the discontinuation numbers, which are a tolerability result and are usually in a supplementary table.
Only then the efficacy figure, and read the interval rather than the point estimate. Finish with the limitations section, which is where the authors say what they actually think.
Fifteen minutes, and you will know more than any thread summarising it.
Spent an evening with the appendix tables and found the subgroup detail that the entire thread had been speculating about.
Spent an evening with the appendix tables and found the subgroup detail that the entire thread had been speculating about.
Adding the check nobody runs — the registered protocol is public and takes two minutes to compare.
Disagree — that figure is from the diabetes programme and you are quoting it as an obesity endpoint.
Disagree — that figure is from the diabetes programme and you are quoting it as an obesity endpoint.
This is the distinction that would end about half the arguments on this board.
Intention-to-treat analyses everybody randomised regardless of what they did afterwards. Completer analyses only those who finished. The second is systematically more flattering and both are legitimate if labelled.
Correction: SURMOUNT is the obesity programme and SURPASS is the diabetes one. The figure you quoted belongs to the other one.
This. Intention-to-treat versus completer analysis routinely moves the headline by several points.
That is a relative risk reduction. Quoting it without the absolute numbers overstates the case considerably.
phase 2 finds a dose, phase 3 measures the effect
the confidence interval is the finding, the point estimate is the headline
Yes. The appendix tables are where the subgroup and the adverse event detail actually live.
a mean is not a promise