@AppleHelix I am pretty sure GLP-1 tolerability is largely determined by initial exposure. Even at low Cmax’es there are issues. The key is to have constant GLP-1 engagement for the tolerability to subside. That is why the Pfizer twice daily had huge tolerability issues.
@AppleHelix Look at the beta arrestin and internalization properties of tirzepatide vs GLP-1(Willard et al 2020). It is a biased agonist leading to increased GLP-1 surface expression. Studies have shown that if you modify semaglutide to make it more beta arrestin biased weight loss increases