TirzTom said:

Steady state is faster than people expect: half-life about five days, so you are at plateau in roughly three to four weeks rather than five.

Pushing back on TirzTom here. The "tirzepatide is simply better" summary irritates me. It is better on mean weight loss, and the cardiovascular outcome evidence is far thinner than semaglutide's. If the reason for treating is cardiovascular risk rather than weight, the evidence base points the other way.

One concrete data point for the thread. Relative versus absolute is the distinction that gets lost: a 20% relative reduction on a high baseline risk is a large absolute benefit, and the same relative figure on a low baseline risk is a small one.

NurseKim_ATL said:

The "tirzepatide is simply better" summary irritates me.

There is a second half to this that has not been said yet. SELECT is the trial that changed the framing of this class, because it was an outcome trial rather than a weight trial: about a 20% relative reduction in major adverse cardiovascular events in people with established cardiovascular disease and overweight or obesity, without diabetes. The effect appeared earlier than the weight-loss curve can comfortably explain, which is the basis for arguing that some of the benefit is direct — anti-inflammatory and vascular — rather than purely a consequence of weight.

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

Whether anyone has held 10mg long term rather than climbing, and what happened over the following year?

Reporting back.

Update: the eight-week restart pattern people described is exactly what happened. I nearly abandoned it at week five.