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Our findings extend this picture in several directions: the longer observation window captures the tirzepatide market-entry period more completely, the mixed-indication cohort reflects a broader prescribing population, and the transition-level framework characterizes switching propensity conditional on observed opportunities rather than treating switching as a single binary outcome within a fixed follow-up window

Abstract Combination therapy with a sodium-glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1RA) is increasingly used to prevent cardiovascular events

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