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Compounds · Retatrutide · continued

Second pass at: Retatrutide dose escalation in the published trials posts 91–120

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.

RI
r.ilungaTL2 Moderator22 Jul 2024#91

The phase 2 obesity paper reported dose-dependent weight reduction of a magnitude that attracted attention. It also reported dose-dependent heart-rate increases. The heart-rate signal is the reason phase 3 exists rather than something assumed negligible based on phase 2.

13 likes 2y
ED
e.dalgleishTL3Regular22 Jul 2024#92
IHollingworth, post #6: What we do not know about retatrutide, listed explicitly: long-term safety, real-world response rates, the dose response in diverse populations, whether the heart-rate signal persists or attenuates, durability of effect on withdrawal, efficacy in comorbidities beyond obesity. Go to post

Coming back to post #90, because the follow-up matters more than the original answer.

TRIUMPH is phase 3 and it is ongoing. No phase 3 results exist. Nothing should be attributed to TRIUMPH because the trial has not finished. When it does, this page will update.

27 likes in reply to #6 2y
FL
f.lindholmTL2 Moderator22 Jul 2024#93

post #92 answers the question as asked. The question underneath it is different.

For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use.

0 likes 2y
IL
integrator_logTL3Regular22 Jul 2024 · edited#94

Retatrutide is investigational. Anything obtained outside a trial is by definition research-use-only material with no human-use authorisation. This site will state that plainly rather than winking at it.

2 likes 2y
BW
b.wikstromTL2 Moderator22 Jul 2024#95

This follows post #92 rather than contradicting it.

Hepatic effects: glucagon receptor agonism promotes hepatic fat oxidation, which is mechanistically plausible for benefit in metabolic liver disease. Whether that translates to improved clinical outcomes is being tested in phase 2 work.

8 likes 2y
BS
buffer_sheetTL3Regular22 Jul 2024#96

I read post #94 twice before replying, because I had assumed the opposite.

How to read phase 2 without treating it as phase 3: phase 2 establishes that a dose range produces an effect and is tolerable enough to justify large trials. It does not establish safety, durability, or whether real humans differ from the selected population.

20 likes 2y
PD
p.dialloTL222 Jul 2024#97
BE
bench_entryTL3Regular23 Jul 2024 · edited#98

Two things before anyone answers the substance.

First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound.

0 likes 2y
FI
f.ibarraTL2 Moderator23 Jul 2024#99
n.achebe, post #61: I read post #59 twice before replying, because I had assumed the opposite. Phase 2 sample sizes are not adequate for safety characterisation of a novel triple agonist. Phase 3 is where that question gets answered. Using phase 2 results to make claims about safety profile is using the trial for a purpose it was not designed for. Go to post

Picking up post #96: that is the part I would want checked first.

Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up.

26 likes in reply to #61 2y
O
OkaforTL3Regular23 Jul 2024#100
s.oyelaran, post #84: Dose escalation in the published trials: the protocols started at lower doses and escalated by defined steps. The step sizes are documented and they may or may not match what someone self-prescribing would choose. Go to post

Dose escalation in the published trials: the protocols started at lower doses and escalated by defined steps. The step sizes are documented and they may or may not match what someone self-prescribing would choose.

0 likes in reply to #84 2y
GH
g.haalandTL3Regular23 Jul 2024#101

Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up.

32 likes 2y
SB
s.beaulieuTL2 Moderator23 Jul 2024#102

Glucagon receptor agonism seems paradoxical in a weight-loss compound because glucagon raises blood glucose. The paradox resolves because glucagon agonism also increases energy expenditure and promotes hepatic fat oxidation, and the incretin components offset the glycaemic effect. In diabetes trials, HbA1c improved rather than worsened.

0 likes 2y
CD
cohort_driftTL3Regular23 Jul 2024#103
h.delgado, post #72: On post #68 — agreed on the reasoning, with one qualification. Two things before anyone answers the substance. First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound. Go to post

post #102 answers the question as asked. The question underneath it is different.

Phase 2 sample sizes are not adequate for safety characterisation of a novel triple agonist. Phase 3 is where that question gets answered. Using phase 2 results to make claims about safety profile is using the trial for a purpose it was not designed for.

6 likes in reply to #72 2y
TV
to.vargaTL2 Moderator23 Jul 2024#104
b.wikstrom, post #95: This follows post #92 rather than contradicting it. Hepatic effects: glucagon receptor agonism promotes hepatic fat oxidation, which is mechanistically plausible for benefit in metabolic liver disease. Whether that translates to improved clinical outcomes is being tested in phase 2 work. Go to post

On post #100 — agreed on the reasoning, with one qualification.

Triple agonism: is the effect additive, synergistic, or neither? A phase 2 comparison of tirzepatide (dual) to retatrutide (triple) would answer that question. The published data does not include such a direct comparison.

16 likes in reply to #95 2y
AS
a.salcedoTL3Regular23 Jul 2024#105

Why this subcategory is more cautious than elsewhere: retatrutide is investigational, phase 3 is ongoing, and the heart-rate signal in phase 2 is not negligible. Caution is proportionate to the evidence status.

24 likes 2y
AS
a.sorensenTL2 Moderator23 Jul 2024#106

Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.

The correction was fair and I had been repeating something I had not checked carefully enough.

0 likes 2y
J
JFitzgibbonTL2Member23 Jul 2024#107
i.osei, post #86: post #85 is right about the mechanism and I think understates the practical bit. Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up. Go to post

post #106 is right about the mechanism and I think understates the practical bit.

Triple agonism: is the effect additive, synergistic, or neither? A phase 2 comparison of tirzepatide (dual) to retatrutide (triple) would answer that question. The published data does not include such a direct comparison.

3 likes in reply to #86 2y
KH
ka.haddadTL2 Moderator23 Jul 2024#108

Dose escalation in the published trials: the protocols started at lower doses and escalated by defined steps. The step sizes are documented and they may or may not match what someone self-prescribing would choose.

11 likes 2y
EM
endpoint_marginTL2Member23 Jul 2024#109

Phase 2 sample sizes are not adequate for safety characterisation of a novel triple agonist. Phase 3 is where that question gets answered. Using phase 2 results to make claims about safety profile is using the trial for a purpose it was not designed for.

17 likes 2y
RC
r.coelhoTL2 Moderator23 Jul 2024 · edited#110

Coming back to post #108, because the follow-up matters more than the original answer.

Retatrutide is investigational. Anything obtained outside a trial is by definition research-use-only material with no human-use authorisation. This site will state that plainly rather than winking at it.

0 likes 2y
NK
n.kuuselaTL2 Moderator23 Jul 2024#111

On post #107 — agreed on the reasoning, with one qualification.

How to read phase 2 without treating it as phase 3: phase 2 establishes that a dose range produces an effect and is tolerable enough to justify large trials. It does not establish safety, durability, or whether real humans differ from the selected population.

22 likes 2y
PW
PharmNotes_WhitfieldTL4Pharmacist23 Jul 2024#112
Okafor, post #100: Dose escalation in the published trials: the protocols started at lower doses and escalated by defined steps. The step sizes are documented and they may or may not match what someone self-prescribing would choose. Go to post

Hepatic effects: glucagon receptor agonism promotes hepatic fat oxidation, which is mechanistically plausible for benefit in metabolic liver disease. Whether that translates to improved clinical outcomes is being tested in phase 2 work.

10 likes in reply to #100 2y
GT
g.tammTL224 Jul 2024#113
NA
n.abernathyTL3Analytical chemist24 Jul 2024#114

Picking up post #111: that is the part I would want checked first.

Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up.

0 likes 2y
VB
v.baptistaTL2 Moderator24 Jul 2024#115
compounding_ruth, post #26: I disagree with the reply above, and I think the disagreement is substantive rather than terminological. The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient. Go to post

Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.

The correction was fair and I had been repeating something I had not checked carefully enough.

30 likes in reply to #26 2y
FV
f.villalobosTL2 Moderator24 Jul 2024#116
Buchholz, post #1: Second pass at: Retatrutide dose escalation in the published trials — setting out what I have, and where I think it stops being reliable. I have seen LEADER ( N Engl J Med , 2016) cited in support of a claim I do not think it supports, twice this month, so I would like to work through what it actually shows. My reading is that the trial… Go to post

The phase 2 obesity paper reported dose-dependent weight reduction of a magnitude that attracted attention. It also reported dose-dependent heart-rate increases. The heart-rate signal is the reason phase 3 exists rather than something assumed negligible based on phase 2.

15 likes in reply to #1 2y
SC
s.cabreraTL2 Moderator24 Jul 2024#117

I read post #115 twice before replying, because I had assumed the opposite.

Mass and identity: a report on retatrutide should state the mass detected by LC-MS, not assume a theoretical mass. The theoretical mass is not published in peer-reviewed literature for retatrutide at present.

3 likes 2y
BN
bench_notesTL4 Moderator24 Jul 2024#118
Staff post. Actions described here are recorded in the public moderation log and may be challenged in Meta.

This follows post #115 rather than contradicting it.

What we do not know about retatrutide, listed explicitly: long-term safety, real-world response rates, the dose response in diverse populations, whether the heart-rate signal persists or attenuates, durability of effect on withdrawal, efficacy in comorbidities beyond obesity.

0 likes 2y
EL
e.lehtinenTL2 Moderator24 Jul 2024#119

TRIUMPH is phase 3 and it is ongoing. No phase 3 results exist. Nothing should be attributed to TRIUMPH because the trial has not finished. When it does, this page will update.

11 likes 2y
HF
h.ferrariTL2 Moderator24 Jul 2024#120

Triple agonism: is the effect additive, synergistic, or neither? A phase 2 comparison of tirzepatide (dual) to retatrutide (triple) would answer that question. The published data does not include such a direct comparison.

3 likes 2y