PharmacoVig_BOS said:The gap between trial results and real-world results is consistent and it is not fraud.
This is where I part company with the consensus forming above. I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them. The results probably generalise, and "probably" should be stated as an assumption rather than dropped.
hannah_MT said:My own curve sits about four points below the published mean and I spent two months assuming that meant something was wrong with me or with my…
hannah_MT said:...regarding the trial evidence...
I think this is an underappreciated point. To expand on it with some data:
A recent meta-analysis of 18 RCTs (n=15,600) found that the trial evidence was associated with a robust effect size across diverse patient populations[1].
The NNT was 15, which is comparable to antihypertensives for stroke reduction. That's a strong clinical argument for this approach.
NurseKim_ATL said:I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them.
Propensity score matching studies and the trial evidence: when RCTs aren't available for a specific question, propensity score-matched observational studies can provide useful evidence.
A recent PSM study of 18,000 GLP-1 users vs matched controls showed reduced MI incidence (HR 0.78) over 4 years of follow-up[1].
These results complement the RCT data and suggest the benefits translate to real-world populations.
[1] Registry-based cohort study, pre-print 2024.
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View ResultsA narrower follow-up, since the general answer is now clear:
Did your prescriber agree with that reading, and if not what was their objection?
Closing the loop on my own question.
Follow-up: I read the paper rather than the summary and the qualifier I was missing was in the second paragraph of the results.