Concretely: 12.5 mg · liraglutide.
The failure mode I am trying to avoid is making this decision emotionally.
I have twelve months in view and I would like the plan to survive that long.
What would you do, and what would make you change course?
12.5 mg a week is 1.786 mg a day averaged out and 650 mg over a year — but "defensible" is not a property of the number, it is a property of where the number came from. A maintenance dose is defensible when a trial randomised people to it and reported what happened, and indefensible when it was arrived at by interpolation between two doses that were studied. So the question to ask of 12.5 mg is which arm it corresponds to: if a programme ran 12.5 mg as a maintenance level, there is an efficacy figure, a tolerability figure and a discontinuation rate attached to it. If it sits between two studied levels, everything said about it is extrapolation, and the burden of that is on whoever proposed it. The other half of the arithmetic is supply: at 12.5 mg a week a 10 mg vial is 0.8 weeks and you will need about 65 of them a year, which is worth knowing before the dose is settled rather than after. Maintenance doses are set by a prescriber against an individual; nothing here is medical advice.
This is a question the trial programmes answered only partially, and it is worth saying which parts are evidenced.
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.
If the result deteriorates on a lower dose, returning to the previous one is straightforward and does not require re-titration from the bottom provided the gap has been short.
Dose-response for weight in the trial programmes was real but flattening at the upper end, which is consistent with a lower maintenance requirement.
Inference from the withdrawal trials to dose reduction is inference and should be labelled as such.
The withdrawal trials answer stopping, not reducing. Different questions.
Aggregated, published test results and vendor ratings built from submitted batches. Methodology stated, dataset browsable, no listing fees.
Browse resultsAny reduction takes four to five weeks to express itself, so the search proceeds in months.
The withdrawal trials — STEP-4 and SURMOUNT-4 — established what happens when treatment stops entirely. They did not evaluate dose reduction, so the evidence for a lower maintenance dose is inference rather than data.
Maintenance and loss are different endpoints. Loss requires a sustained energy deficit; maintenance requires only that the counter-regulatory drive is offset, and that may need less exposure.
Search downward, one step, eight weeks each, on a rolling average.
edited 6 Apr 2026 by t_oyelaran — reworded for clarity after a comment
Answer first: the maintenance dose is the lowest one that holds the result, and finding it is a downward search rather than an upward one.
The maintenance dose is not necessarily the same a year later, since the counter-regulatory response attenuates slowly if at all.
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.
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.
The short version: reach a working dose, hold it, and then consider whether less would hold it just as well.
Weight is a noisy signal. A rolling four-week average is the instrument; single weigh-ins after a dose reduction will show nothing interpretable.
Glycaemic maintenance gives a faster signal than weight maintenance.
Start with what is being maintained — weight, glycaemia or both — because they have different dose-response curves.
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.
STEP-4 and SURMOUNT-4 evaluated withdrawal rather than dose reduction, which is the limit of the direct evidence on this question.
Going back up after a short gap does not require re-titrating from the bottom.
edited 5 Jan 2026 by Dr_Rosalind_Achebe — added a caveat about sampling
Ask PeptideStack is a static archive. Posting is closed, but the norms are worth stating: answer the question that was asked, show your working, cite the trial or the certificate, and say plainly where the evidence runs out.