Taking the question as asked, rather than the general version of it. Extending the interval and reducing the dose are pharmacologically different. Reducing the dose lowers the whole exposure curve evenly; extending the interval keeps the peak and drops the trough. Since the appetite effect tracks the trough, interval extension tends to give you good days and bad days rather than a uniformly smaller effect, which most people find harder to live with.

BethLabQueen said:

Extending the interval and reducing the dose are pharmacologically different.

That holds for the injectable. The oral formulation has different absorption behaviour and the dose numbers are not interchangeable, which is worth saying out loud because people quote them as if they were.

Ask again with the specifics and you will get a better answer than this one.

mike_nyc said:

I am eight weeks into deliberately reducing rather than stopping, and the appetite change came back faster than the weight did.

This matches mine closely enough to be worth saying so. STEP 4 is the study that answers this and it is blunt. Participants who continued kept losing; participants switched to placebo regained about two thirds of what they had lost within a year, and the metabolic improvements faded with the weight. That is the same pattern as every other chronic-disease medication ever withdrawn, and it is an argument about the condition rather than about the drug.

Adding the clinical framing, because it changes how the question reads.

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.