Six months in at 2.4mg. The first four months were close to the trial curve and the last two have been flat, which is roughly what the STEP 1 figure predicts if you read the tail rather than the headline.
What I am trying to establish is how much of the between-person variation is pharmacokinetic and how much is just adherence measured badly.
I have searched first, so if this is covered somewhere point me at it and I will read it.
Answering the narrow version, because the broad one does not have a single answer. 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.
PeptideChemSF said:Steady state is the thing most people miss.
PeptideChemSF has the substance of this right. The condition it depends on is worth stating. 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.
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Browse GL BiochemDr.NutriCornell said:The first four months were close to the trial curve and the last two have been flat, which is roughly what the STEP 1 figure predicts if you read the…
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.
Adding the clinical framing, because it changes how the question reads.
Dr.NutriCornell said:...but the FDA says semaglutide...
Interesting point. I want to add some regulatory nuance: the FDA labeling reflects the specific clinical trial data submitted for approval. Real-world clinical practice often extends beyond the FDA label based on emerging evidence and clinical judgment.
Example: semaglutide was first approved for diabetes (Ozempic), then obesity (Wegovy). The molecule didn't change — our understanding of its applications expanded. Similarly, semaglutide may evolve as more data accumulates.