SURMOUNT-OSA: tirzepatide and sleep apnea AHI reduction — 6 month update

Dr.SleepRoch said:

Steady state is faster than people expect: half-life about five days, so you are at plateau in roughly three to four weeks rather than five.

I read this differently from Dr.SleepRoch, on substance rather than tone. 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.

One concrete data point for the thread. Practical numbers: half-life about 5 days, steady state 3 to 4 weeks, ladder 2.5 / 5 / 7.5 / 10 / 12.5 / 15mg, and the maintenance doses with published data behind them are 5, 10 and 15mg.

SarahChen_PharmD said:

The "tirzepatide is simply better" summary irritates me.

There is a second half to this that has not been said yet. SURMOUNT-1 landed around 20.9% mean weight loss at 15mg over 72 weeks, against roughly 15% for semaglutide 2.4mg in STEP 1. Different trials, different populations, so the comparison is indicative rather than decisive — but SURPASS-2 was a genuine head-to-head and it pointed the same way.

Following on from FitDadDave — and this may be the naive question:

Whether anyone has held 10mg long term rather than climbing, and what happened over the following year?

Closing the loop on my own question.

Update: the eight-week restart pattern people described is exactly what happened. I nearly abandoned it at week five.