BethLabQueen 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.

Worth separating that from semaglutide, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

If somebody has the primary source to hand I would rather cite it than paraphrase it.

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.

Dr.PainCLE said:

The regain framing needs pushing back on.

Coming at Dr.PainCLE’s question from a different direction. Steady state is the thing most people miss. The terminal half-life is about a week, so every dose step takes four to five weeks to fully express itself. Judging a step at day ten is judging the ascent, not the plateau, and it is the single commonest reason people escalate before they needed to.

I would rather be corrected than agreed with, if it comes to it.

A narrower follow-up, since the general answer is now clear:

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

Reporting back.

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.