Example: A person already taking metformin 1000 mg twice daily may be evaluated for a combination that keeps a similar daily metformin amount while adding sitagliptin
## What the Research Says About Missed Doses and Breaks ### The STEP 4 Study: What Happens When You Stop The STEP 4 trial, published in *JAMA* (2021), provided the most direct evidence of what happens when semaglutide is discontinued: - Participants took semaglutide for 20 weeks, then were randomized to either continue or switch to placebo - Those who continued lost an additional 7.9% body weight over the next 48 weeks - Those who switched to placebo **regained approximately two-thirds** of their lost weight within one year - Metabolic improvements (blood sugar, cholesterol, blood pressure) also partially reversed **Key takeaway**: Consistent dosing is essential for maintaining results
Differences in clinical efficacy have been observed in headtohead comparisons between GLP1RAs in randomised controlled trials
V., Hao, L., Offermanns, S
Lancet 364 , 16991700 (2004)
