Semaglutide vs Tirzepatide Dosages for Weight Loss

To the Editor The Original Investigation by Rodriguez et al compared the effectiveness of semaglutide and tirzepatide, each labeled for type 2 diabetes (T2D), in promoting weight loss among adults with overweight or obesity. Tirzepatide was associated with greater weight loss than semaglutide. However, the study did not account for differences in dosages, despite the known dose-response relationship with weight loss for both medications. Accounting for dosage is especially important given that only formulations labeled for T2D were assessed. Consequently, it is likely that semaglutide users receiving the 2.4-mg dosage regimen—the higher dosing recommended only for weight loss—were excluded.

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Febbraio 2025

Bilateral Mastectomy vs Lumpectomy and Breast Cancer Mortality Risk—Reply

In Reply O’Keefe and colleagues raise salient points regarding the interpretation of the data presented in our article on bilateral mastectomy and the risk of breast cancer mortality. In this article, we showed that experiencing a contralateral cancer greatly increased the mortality rate, but preventing contralateral breast cancer with bilateral mastectomy did not mitigate the risk. The authors propose that residual confounding due to variables that are unaccounted for in the Surveillance, Epidemiology, and End Results (SEER) database are a plausible explanation for this apparent enigma.

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Febbraio 2025

Semaglutide vs Tirzepatide Dosages for Weight Loss—Reply

In Reply We appreciate the commentary by Levy et al related to our comparative effectiveness study of semaglutide and tirzepatide, with the suggestion that a direct comparison be made between the 2 drugs by dosage regimen. Although we agree that dosages plays a critical role in weight change outcomes, dose comparisons were intentionally omitted from our study because of the potential for bias. Dose-response relationships have been assessed in randomized clinical trials in which doses are assigned at baseline. However, in real-world settings, where doses are escalated over time based on tolerability and response, dose comparisons may threaten internal and external validity.

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Febbraio 2025