Putting this up for argument rather than for agreement. I have read it twice and I am still not certain what it supports.
The apnoea data is some of the strongest non-weight evidence in the class. SURMOUNT-OSA showed large reductions in apnoea-hypopnoea index on tirzepatide, with a meaningful fraction of participants improving enough to change their treatment category. Mechanistically it is upper-airway fat and reduced abdominal load rather than anything neurological, which is why the effect tracks weight loss closely.
Where I think it is weakest: the comparator does most of the work in how this gets reported, and it is not the comparator most people think they are citing.
What I am trying to establish is what people did about re-titration, because feeling better is not the same as a study saying you are better. Happy to be told the question itself is wrong.
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
SleepDoc_PDX said:The apnoea data is some of the strongest non-weight evidence in the class.
Agreed on the mechanism, with the caveat that the head-to-head used semaglutide 1mg, not 2.4mg. It is still the best direct evidence available, but it is not the comparison most people think they are citing.
SleepDoc_PDX said:The apnoea data is some of the strongest non-weight evidence in the class.
This is where I part company with the consensus forming above. 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.
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View ResultsThis one has a reasonably settled answer, so here it is. The GIP arm is doing real work rather than padding the label. GIP receptor agonism appears to improve adipose insulin sensitivity and lipid handling, and — counter-intuitively — GIP signalling in the CNS reduces nausea rather than adding to it, which is why tolerability at high total agonism is better than the GLP-1-only comparison would predict. SURPASS-2 is the cleanest head-to-head: tirzepatide beat semaglutide 1mg at every dose tier.
LarryQC_SD said:Agreed on the mechanism, with the caveat that the head-to-head used semaglutide 1mg, not 2.4mg.
This is my experience too, for whatever a second data point is worth. Posting only so the count is not one.