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ForumsCardiovascular OutcomesSOUL trial preliminary data — 6 month update

SOUL trial preliminary data — 6 month update

pete_RVA Mon, Oct 27, 2025 at 8:34 PM 9 replies 1,081 viewsPage 1 of 2
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pete_RVA
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Oct 27, 2025 at 8:34 PM#1

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 material.

A quick sanity check on any figure quoted here: is it mean or median, is it intention-to-treat or completers, and what was the comparator. Three questions, and they resolve most disagreements in these threads.

So the question, as narrowly as I can put it: how to read a result like this without either dismissing it or over-reading it, since the summaries all read like press releases.

Practical detail welcome, however dull — the duller the better.

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anders_CPH
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Oct 27, 2025 at 9:54 PM#2

Answering the narrow version, because the broad one does not have a single answer. Read four things before the headline number. The population, because trial populations are selected and supported in ways that real cohorts are not. The comparator, because "better than placebo" and "better than the current standard" are different claims and get reported identically. The primary endpoint as pre-registered, because a secondary endpoint promoted after the fact is a hypothesis rather than a finding. And the completion rate, because a large effect in the half of participants who finished is a different result from a large effect in everybody enrolled.

Last edited: Oct 28, 2025 at 1:54 AM
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alex_tucson
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Oct 27, 2025 at 11:14 PM#3
anders_CPH said:
Read four things before the headline number.

Bayesian meta-analysis perspective on the trial evidence: traditional frequentist meta-analyses report point estimates and confidence intervals. Bayesian approaches provide probability distributions that are more intuitive for clinical decision-making.

For example: "There is a 98.5% probability that semaglutide 2.4mg produces >10% weight loss vs placebo" is more actionable than "RR 3.4, 95% CI 2.8-4.1, p<0.001."

The the trial evidence evidence is strong under both frameworks, but Bayesian analysis better communicates the degree of certainty for individual patient counseling.

Last edited: Oct 28, 2025 at 1:14 AM
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NicoleRaleigh
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Oct 28, 2025 at 12:34 AM#4
pete_RVA 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…

Can confirm the pattern pete_RVA describes. Relative and absolute effects need reading together. A 20% relative reduction on a high baseline risk is a large absolute benefit; the same relative figure on a low baseline risk is a small one, and press summaries almost always quote the relative number because it is bigger.

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james_edin
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Oct 28, 2025 at 8:17 AM#5

Clinical perspective, offered as context rather than as advice.

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 25,000 GLP-1 users vs matched controls showed reduced stroke risk (HR 0.82) over 5 years of follow-up[1].

These results complement the RCT data and suggest the benefits translate to real-world populations.

References:
[1] Registry-based cohort study, pre-print 2024.
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