Does extending the interval work as well as reducing the dose?

My records go back to the first dose with dates, so I can reconstruct the timeline exactly.

These are treated as interchangeable and I do not think they are.

If both are acceptable I would like to know that, so I can stop thinking about it.

Under what conditions does the answer flip?

It helps to be literal here: any reduction takes four to five weeks to express itself, so the search proceeds in months.

Glycaemic maintenance has a faster and cleaner signal than weight maintenance, particularly with continuous monitoring, which makes the downward search more tractable when glycaemia is the endpoint.

Stated carefully, gastrointestinal tolerability generally improves on a reduced dose, which is a genuine quality-of-life argument for the search rather than only a cost one.

STEP-4 and SURMOUNT-4 evaluated withdrawal rather than dose reduction, which is the limit of the direct evidence on this question.

Search downward, one step, eight weeks each, on a rolling average.

Answering this needs the reason for the current dose, since a dose chosen for loss and a dose chosen for maintenance are different decisions.

A downward search proceeds one step at a time with at least eight weeks at each level, because a weekly agent takes four to five weeks to reach the new steady state and then needs time for the trend to be readable.

Specifically, the maintenance dose is not necessarily the same a year later, since the counter-regulatory response attenuates slowly if at all.

Gastrointestinal adverse event rates in the trials are dose-related, which supports the tolerability argument for the lowest effective dose.

The lowest dose that holds the result is the answer, and it is individual.