SURMOUNT-OSA: tirzepatide and sleep apnea AHI reduction — what worked for you?

NeuroNate said:

SURMOUNT-1 landed around 20.9% mean weight loss at 15mg over 72 weeks, against roughly 15% for semaglutide 2.4mg in STEP 1.

I read this differently from NeuroNate, 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.

I would rather be corrected than agreed with, if it comes to it.

The figures, for anyone assembling their own picture. 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.

Worth separating that from tirzepatide, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

That is the short version; the long version is somebody else's post.

TrialNerd_Beth said:

The "tirzepatide is simply better" summary irritates me.

There is a second half to this that has not been said yet. The GIP arm is doing real work rather than padding the label. GIP receptor agonism appears to improve adipose insulin sensitivity and lipid handling, and — counter-intuitively — GIP signalling in the CNS reduces nausea rather than adding to it, which is why tolerability at high total agonism is better than the GLP-1-only comparison would predict. SURPASS-2 is the cleanest head-to-head: tirzepatide beat semaglutide 1mg at every dose tier.

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

How much of the tirzepatide advantage is the GIP component and how much is simply that the dose ladder goes higher in receptor-occupancy terms?

Reporting back.

Reporting back after another eight months at the same dose. Still losing slowly, no new side effects, and no reason I can find to climb further.