how much of what we believe about endpoint actually comes from SURMOUNT threads
Asking properly rather than in a comment on somebody else’s thread: how much of what we believe about endpoint actually comes from SURMOUNT threads.
Compared myself to a trial mean for about six months before realising the trial arm had dietitian contact every fortnight.
The discontinuation numbers were the most useful thing in the paper for me and they were in a supplementary table.
Went looking for the registered protocol to see whether the endpoint had changed. It had not, which was reassuring and worth checking.
Not medical advice, obviously, and nothing here is approved for human use. One person with a spreadsheet.
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.
Same. A press release is a claim about a result; the publication is the result.
Why comparing across trials almost never works, with the specific failure modes.
Different populations: an obesity programme and a diabetes programme enrol different people with different baseline characteristics. Different endpoints: body weight change, glycaemic control and cardiovascular events are not convertible. Different durations: 68 weeks and 72 weeks are not the same, and the curves have not flattened by either.
Different analysis populations: one paper reports intention-to-treat, another emphasises completers. Different support: some trial designs include structured lifestyle contact that no member of this board receives.
Stack those and the "X beats Y" tables that circulate here are comparing five things at once and attributing the difference to the molecule.
discontinuation rate is a result, not a footnote
Yes. The appendix tables are where the subgroup and the adverse event detail actually live.
Argued for a week about a result and then read the limitations section, which conceded most of my opponent’s point.
Yes — the interval is the finding. A point estimate with a wide interval is a hypothesis in a nice font.
Is that intention-to-treat or completers?
Read a press release and the publication three months apart. The hedging in the second one was substantial.
phase 2 finds a dose, phase 3 measures the effect
That is the 68-week readout, not the 72-week one. Different trial, different duration.
a mean is not a promise
Started keeping the trial identifiers straight in a note file because I kept mixing up two programmes in the same sentence.
check who the comparator was before you compare anything
Quoted a figure here confidently, got asked whether it was ITT, went and checked, and it was not. Learned something.
A confidence interval is the range of effects compatible with the data. Two trials with overlapping intervals have not disagreed, whatever their point estimates look like next to each other.
Agreed on comparators. "Superior" means nothing until you know superior to what and at what dose.
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.
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.
Open-label extensions lose their randomisation. Anybody still enrolled at week 104 is a selected group and the numbers describe that group.
Spent an evening with the appendix tables and found the subgroup detail that the entire thread had been speculating about.
Cosigning on discontinuation. It is a result about tolerability and it gets buried every time.
read the endpoint before you read the headline
intention to treat versus completers changes the number substantially
Open-label extensions lose their randomisation.
alcohol_aversion is right about the programme names. They are different populations with different endpoints.
Correction: SURMOUNT is the obesity programme and SURPASS is the diabetes one. The figure you quoted belongs to the other one.
That is a relative risk reduction. Quoting it without the absolute numbers overstates the case considerably.
FLOW was kidney outcomes and it is the one nobody quotes
the appendix is where the interesting tables live
- 1Intention-to-treat analyses everybody randomised regardless of what they did…9 comments in this branch · started by u/emil_agyeman
- 2Read a press release and the publication three months apart. The hedging in…7 comments in this branch · started by u/rina_sobczak