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Compounds · Retatrutide · continued

Second pass at: Retatrutide dose escalation in the published trials posts 31–60

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

OA
o.abrahamsenTL3Regular18 Jul 2024#31

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.

15 likes 2y
RN
r.novakTL2 Moderator18 Jul 2024#32
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

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.

30 likes in reply to #1 2y
C
CSagredoTL3Regular18 Jul 2024#33
e.almeida, post #8: 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

This follows post #30 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.

1 like in reply to #8 2y
HB
h.bhattacharyaTL2 Moderator18 Jul 2024#34

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.

5 likes 2y
BR
buffer_reviewTL3Regular18 Jul 2024#35

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.

10 likes 2y
SV
sa.vogelTL2 Moderator18 Jul 2024#36
t.marchetti, post #5: I read post #3 twice before replying, because I had assumed the opposite. 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… Go to post

On post #32 — agreed on the reasoning, with one qualification.

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.

22 likes in reply to #5 2y
CD
cannula_driftTL3Regular18 Jul 2024#37

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 2y
AM
a.mwangiTL2 Moderator18 Jul 2024#38

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.

3 likes 2y
MD
methods_draftTL2Member18 Jul 2024#39
m.rasmussen, post #23: 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. Go to post

post #38 is right about the mechanism and I think understates the practical bit.

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.

29 likes in reply to #23 2y
MM
m.marchettiTL218 Jul 2024#40
FP
forest_plotTL3Evidence synthesis18 Jul 2024#41

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.

10 likes 2y
AP
a.pereiraTL2 Moderator19 Jul 2024#42

post #41 is right about the mechanism and I think understates the practical bit.

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.

3 likes 2y
QZ
q.zhao_qaTL3Quality assurance19 Jul 2024#43
isotonic_sheet, post #4: the opening post answers the question as asked. The question underneath it is different. 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… Go to post

I read post #41 twice before replying, because I had assumed the opposite.

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.

0 likes in reply to #4 2y
SA
s.antonsenTL2 Moderator19 Jul 2024 · edited#44

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.

31 likes 2y
MS
m.strand_rphTL3Pharmacist19 Jul 2024#45

On post #41 — agreed on the reasoning, with one qualification.

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.

16 likes 2y
CO
c.ostergaardTL2 Moderator19 Jul 2024#46
m.rasmussen, post #23: 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. Go to post

post #45 answers the question as asked. The question underneath it is different.

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.

6 likes in reply to #23 2y
PE
ppm_errorTL3Analytical chemist19 Jul 2024#47

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.

1 like 2y
HB
h.bakkerTL2 Moderator19 Jul 2024#48

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.

0 likes 2y
EP
e.piresTL2 Moderator19 Jul 2024#49

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.

22 likes 2y
AK
a.kowalskiTL2 Moderator19 Jul 2024#50

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.

10 likes 2y
NN
n.norgaardTL2 Moderator19 Jul 2024#51

This follows post #48 rather than contradicting it.

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
MD
m.duarteTL2 Moderator19 Jul 2024#52

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.

1 like 2y
BN
b.nwosuTL2 Moderator19 Jul 2024#53
l.wikstrom, post #17: 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

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.

7 likes in reply to #17 2y
MS
m.stephanopoulosTL3Regular19 Jul 2024#54

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.

18 likes 2y
DT
d.tammTL2 Moderator20 Jul 2024#55

Picking up post #52: that is the part I would want checked first.

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.

0 likes 2y
AN
a.nwosuTL2 Moderator20 Jul 2024#56
e.pires, post #49: 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

Coming back to post #54, 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.

4 likes in reply to #49 2y
OV
o.vogelTL2 Moderator20 Jul 2024#57

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.

12 likes 2y
AZ
a.zamoraTL2 Moderator20 Jul 2024#58

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.

25 likes 2y
DN
d.ndiayeTL2 Moderator20 Jul 2024#59

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.

1 like 2y
DW
diluent_watchTL2Member20 Jul 2024#60

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.

7 likes 2y