Dr.ObesityMed said:Read four things before the headline number.
This is where I part company with the consensus forming above. I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them. The results probably generalise, and "probably" should be stated as an assumption rather than dropped.
DadBodDave said:I keep finding that the number in the press summary and the number in the paper are not the same number, and the difference is always in the same…
Forest plot interpretation for the the trial evidence meta-analysis: when reading the pooled estimate, pay attention to:
- Point estimate (HR/RR/OR) — center of the diamond
- Confidence interval width — precision of the estimate
- I² statistic — heterogeneity across studies
- Individual study weights — are results driven by one large trial?
- Prediction interval — range of plausible true effects in future settings
The the trial evidence meta-analysis shows a pooled RR of 0.83 (95% CI 0.69-0.88), I²=56%. This is a robust and consistent effect.
PharmD_Rodriguez said:I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them.
Propensity score matching studies and the trial evidence: when RCTs aren't available for a specific question, propensity score-matched observational studies can provide useful evidence.
A recent PSM study of 12,000 GLP-1 users vs matched controls showed reduced heart failure hospitalization (HR 0.74) over 3 years of follow-up[1].
These results complement the RCT data and suggest the benefits translate to real-world populations.
[1] Registry-based cohort study, pre-print 2024.
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View ResultsOne thing that is still open after TirzTom’s answer:
How would you tell the difference between that and the alternative explanation?
Reporting back.
Update — my curve sits below the published mean and the explanation is that the trial arm had support I do not have. That was reassuring rather than otherwise.