Weight regain after discontinuation (revision 4)
Old revision·07:05, 27 Sep 2024·AnaesthesiaAoife
| Weight regain after discontinuation | |
|---|---|
| Evidence design | Randomised withdrawal after a lead-in |
| Principal trials | STEP 4, SURMOUNT-4 |
| Observed pattern | Steady regain towards baseline |
| Topic infobox · conventions | |
Weight regain after discontinuation is the return of body weight towards its pre-treatment value when incretin therapy stops. It has been documented in randomised withdrawal trials, which are the design capable of distinguishing it from the natural course of weight in a treated population.[1]
In STEP 4, participants who had reached the maintenance dose during a 20-week run-in were randomised to continue or to switch to placebo. Those continuing lost further weight; those switched regained steadily over the following 48 weeks.[1]
What the withdrawal trials show
[edit]A randomised withdrawal design is necessary because an observational comparison of people who stop with people who continue is confounded: those who stop differ systematically, often having stopped because of intolerance or lack of response.[1]
STEP 4 and SURMOUNT-4 both randomised after a lead-in on active treatment, so both groups had already lost weight and differed only in what followed. Regain in the withdrawn groups was substantial and progressive; neither trial ran long enough to establish whether weight returns fully to baseline.[1]