Round 11 Open Questions
Answered this round
- Tirzepatide in advanced CKD (eGFR <30): ✓ EXCLUDED from all SURPASS trials; FDA label permits use without dose adjustment (not renally cleared); CKD G3 (eGFR 30-59) shows eGFR slope preservation (SURPASS-4 post-hoc, Δ3.7 mL/min/1.73m²/year vs glargine); TREASURE-CKD ongoing for lower eGFR data
- Obstructive sleep apnoea (SURMOUNT-OSA): ✓ NEJM 2024 (n=469): AHI treatment difference −20.0 (no PAP) and −23.8 (on PAP) events/h vs placebo; hypoxic burden, hsCRP, SBP, sleep PROs all improved
Still unanswered
-
NHS patient experience (UK, HealthUnlocked): UK-specific experience with Mounjaro on NHS — what do T2D patients on NHS prescriptions say about access barriers, side effects, continuation criteria, and cost?
-
GIP receptor mechanism vs GLP-1 alone: What does the GIP component of tirzepatide specifically add beyond GLP-1 agonism in T2D? Visceral fat reduction, adipokine modulation, direct islet effects, bone turnover — what is the evidence differential?
-
Long-term weight maintenance in T2D (>2 years): SURMOUNT-4 stopping data shows regain in obesity; is the same true in T2D? Any data beyond 52 weeks on sustained HbA1c and weight outcomes in T2D?
-
Real-world outcomes in T2D vs trial populations: Lilly SURPASS trials are industry-sponsored RCTs with tight inclusion criteria. What do registry or observational studies of real-world tirzepatide use in T2D show — particularly in older patients, multimorbidity, eGFR variability?
-
Cost-effectiveness under NHS TA924: Who is actually accessing tirzepatide via NHS? NICE TA924 criteria — are they being applied consistently? Any prescribing data available?