help me understand SURMOUNT, I have read the wiki twice
Trying to get a straight answer on this: help me understand SURMOUNT, I have read the wiki twice.
Relative risk reduction without the baseline rate is uninterpretable. A large relative reduction on a small absolute risk is a small absolute benefit.
Open-label extensions lose their randomisation. Anybody still enrolled at week 104 is a selected group and the numbers describe that group.
Cardiovascular outcome trials are powered for events, not for weight, and are typically run in a different population with different inclusion criteria. Reading a weight number out of one is reading a secondary endpoint.
Happy to answer the boring questions. Those are usually the ones worth asking.
best — the order this archive was captured in
Discontinuation rates are a tolerability result. A trial with a strong efficacy number and heavy discontinuation is telling you two things and people only quote one.
A confidence interval is the range of effects compatible with the data. Two trials with overlapping intervals have not disagreed, whatever their point estimates look like next to each other.
Intention-to-treat analyses everybody randomised regardless of what they did afterwards. Completer analyses only those who finished. The second is systematically more flattering and both are legitimate if labelled.
Push back: an open-label extension tells you about the people who stayed. That is a different question.
That is the 68-week readout, not the 72-week one. Different trial, different duration.
The press release said that; the publication says something more hedged. Worth reading both.
The registered protocol is public. Comparing the registered primary endpoint with the reported one is a two-minute check and it is how outcome switching gets caught.
Left up and flaired Trial Data. The publication is linked rather than the coverage, which is what we ask for.
Argued for a week about a result and then read the limitations section, which conceded most of my opponent’s point.
Why comparing across trials almost never works, with the specific failure modes.
Different populations: an obesity programme and a diabetes programme enrol different people with different baseline characteristics. Different endpoints: body weight change, glycaemic control and cardiovascular events are not convertible. Different durations: 68 weeks and 72 weeks are not the same, and the curves have not flattened by either.
Different analysis populations: one paper reports intention-to-treat, another emphasises completers. Different support: some trial designs include structured lifestyle contact that no member of this board receives.
Stack those and the "X beats Y" tables that circulate here are comparing five things at once and attributing the difference to the molecule.
Why comparing across trials almost never works, with the specific failure modes.
Adding the check nobody runs — the registered protocol is public and takes two minutes to compare.
The discontinuation numbers were the most useful thing in the paper for me and they were in a supplementary table.
Correction: SURMOUNT is the obesity programme and SURPASS is the diabetes one. The figure you quoted belongs to the other one.
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