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Compliance is inconsistent
Both Novo and Lilly readily acknowledge they are unable to keep up and while a range of competitors from startups to pharma titans are rushing to get their own products to market, it is still going to be years until these products make it and there is no guarantee they will equal or trump the incumbents.
In practice, clinics adapt trial titration schedules by starting most patients at 1 mg once weekly for 24 weeks, which is considered the safest entry point for minimizing GI side effects
doi: 10.1080/14728214.2019.1604684
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