Clinical perspective, offered as context rather than as advice.

VendorMark said:

...the STEP extension data on maintenance dosing is concerning...

Let me offer a different interpretation of the same data. Yes, 2/3 of weight was regained after discontinuation. But consider:

• This is consistent with EVERY chronic disease medication ever studied
• 1/3 of patients maintained significant weight loss — who are they and why?
• The metabolic improvements partially persisted even with weight regain
• The data supports long-term treatment, not a "course" of therapy

The takeaway isn't "the drug fails when you stop" — it's "chronic diseases require ongoing treatment." We've always known this.

Dr.KarenChen said:

VendorMark said: ...the STEP extension data on maintenance dosing is concerning...

Mine went the same way, slower. The detail I would add is minor and it is already implied above.

Dr.KarenChen said:

VendorMark said: ...the STEP extension data on maintenance dosing is concerning...

Adding the part of the answer the thread has not reached. The mechanism that matters here is not stomach emptying, it is central. GLP-1 receptor agonism in the arcuate nucleus stimulates POMC neurons and suppresses AgRP/NPY signalling, which is why the effect is appetite and food salience rather than physical fullness. Delayed gastric emptying largely tachyphylaxes over the first months; the appetite effect does not.

Adding the numbers, since they settle part of this. Give anything pharmacological four weeks before you judge it, and give anything measured weekly a four-point rolling average before you call it a trend.

One thing that is still open after Dr.KarenChen’s answer:

Whether anyone has held at a sub-maximal dose long term and kept the result, or whether the maintenance data only exists at 2.4mg?