Comment by s1artibartfast
10 hours ago
I worked in pharmaceutical development and absolutely agree on the labeled dosing point. When each arm of your study costs X00 million dollars and Y years, you dont optimize dosing intervals. Moreover, there is no global optimum due to biologic variability in patients. Some patients are flat out non-responders, and some tolerate dosing intervals 10X the average.
That said, there is nothing magic about aligning the half-life and interval. 50% isn't a minimum concentration threshold for efficacy. depending on the product, it can be anything. Sometimes area under the curve is the relevant parameter. Sometimes you want the product to go under a limit before redosing.
The one part I disagree with is about bleeding edge doctors. Maybe it is my field, but I find doctors to be readily willing to completely ignore the labeling. Statutory protections are high for clinicians operating off label. If someone is interested, I suggest they raise it with their doctor. For most medications, the dosing is far from the individual optimum.
Fair on the doctor part - I've found doctors to be pretty reluctant to go off label for such things like dosing schedule on these new drugs. YMMV.
Re: the half-life, I generally agree - however at low dosing, a half-life calculator seems to coincide with some folks experience with side effects - especially starting out initially. Once the dosing levels go up, the impact is much less - but even I at my peak weight loss at a mid-dosing level could tell a difference in hunger levels if I had to wait a few days due to travel or whatnot.
All of the GLP-1 products are self administered, unless I am mistaken, so there is always the trump card. "Hey doc, just so you know Im injecting every 5 days instead of 7 because Im getting hungry"
You’re 100% right on the doctor. You also never know the why - some will write scripts to address insurance constraints as well.