Draft synthesis: weight change after discontinuation of an incretin receptor agonist
Consultation on the draft synthesis of weight trajectory after an incretin receptor agonist is stopped. The contributing evidence is drawn principally from the randomised withdrawal designs in STEP 4, reported in JAMA in 2021, and SURMOUNT-4, reported in JAMA…
§1Consultation and window
§1.1Window
- Opened
- 30 July 2025
- Closed
- 28 September 2025
- Duration
- 60 days
- Status
- Closed — the disposition is published
- Document under consultation
- Synthesis: Weight change after discontinuation of an incretin receptor agonist
- Submissions received
- 16
§1.2Consultation questions
The secretariat put the following questions. A submission was not required to address them and several did not; the questions record what the Institute was uncertain about rather than restricting what a respondent could raise.
- Is the moderate certainty rating for the anchor outcome correctly drawn, given that the contributing designs differ in the duration of the run-in before randomised withdrawal?
- Is any eligible study missing from the included set, and is any included study ineligible under the registered criteria?
- Does the synthesis state clearly enough that a randomised withdrawal design measures the effect of stopping a drug in people who tolerated and responded to it, and not the effect of stopping it in an unselected population?
§1.3How a submission is handled
- Every submission is signed. The Institute publishes no anonymous submission.
- Every submission carries a declared interest. A declaration of no interest is itself a declaration and is recorded as one. A declaration is not a disqualification and the Institute has never given a submission less weight on that ground.
- A submission from an employee of a marketing-authorisation holder is identified as an industry submission on its face, following a unanimous consultation on the conflicts policy.
- Every submission receives a secretariat response and a disposition. Submissions that are not accepted remain published in full; the Institute does not remove a submission because it disagrees with it.
- There is no voting, no reputation score, no reply thread and no editing after receipt.
§1.4Outcome
The synthesis was amended before ratification. The selection effect inherent in a randomised withdrawal design is now stated in the abstract, and the trajectory is reported per trial rather than pooled across trials of different run-in duration.
The disposition table, listing each submission with its disposition and the resulting amendment, is at §3.