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Massad said

In SURMOUNT-4 (Aronne et al., *JAMA* 2024), all patients ran an open-label phase reaching maximum tolerated dose (10 mg or 15 mg weekly) for 36 weeks, losing an average of 20.9% of body weight in that phase

The mechanism is analogous to building a house: the construction crew (dihexa) leaves after a few hours, but the structure (synaptic remodeling) remains