FlexNP
@rnflex.bsky.social
Jack of all trades nurse practitioner, trail runner photographer, coonhound rescuer, lover of glucagon agonism in the liver, kidney and pancreas, fascinated by obesity medicine, retatrutide fan boy
CC: @mikejohansenmd.medsky.social
In what might be one of the hilariously beneficial Kaplan Meier curves I've ever seen. TTE study of GLP1 meds and alcohol use disorder with the top left graph being incident of alcohol use tirzepatide vs DPP-4i
dom-pubs.onlinelibrary.wiley.com/doi/full/10....
In what might be one of the hilariously beneficial Kaplan Meier curves I've ever seen. TTE study of GLP1 meds and alcohol use disorder with the top left graph being incident of alcohol use tirzepatide vs DPP-4i
dom-pubs.onlinelibrary.wiley.com/doi/full/10....
November 11, 2025 at 5:04 PM
CC: @mikejohansenmd.medsky.social
In what might be one of the hilariously beneficial Kaplan Meier curves I've ever seen. TTE study of GLP1 meds and alcohol use disorder with the top left graph being incident of alcohol use tirzepatide vs DPP-4i
dom-pubs.onlinelibrary.wiley.com/doi/full/10....
In what might be one of the hilariously beneficial Kaplan Meier curves I've ever seen. TTE study of GLP1 meds and alcohol use disorder with the top left graph being incident of alcohol use tirzepatide vs DPP-4i
dom-pubs.onlinelibrary.wiley.com/doi/full/10....
Primary care is really really hard most days. But when you get notes like this. It makes everything worth it.
November 11, 2025 at 2:31 PM
Primary care is really really hard most days. But when you get notes like this. It makes everything worth it.
Another day another telmisartan and tirzepatide combo prescribed. It's like the Konami cheat code combo for dyslipidemia, high blood pressure and obesity +/- diabetes.
a man in a purple shirt and tie is sitting at a table .
ALT: a man in a purple shirt and tie is sitting at a table .
media.tenor.com
November 10, 2025 at 11:00 PM
Another day another telmisartan and tirzepatide combo prescribed. It's like the Konami cheat code combo for dyslipidemia, high blood pressure and obesity +/- diabetes.
We invented the most powerful weight loss drug ever and it might be an effective oncology drug too 😳🤯
"Low-dose RETA significantly reduced tumor volume by 3-fold compared to vehicle, demonstrating efficacy comparable to anti-PD-1 therapy, which achieved a 5-fold reduction in tumor volume"
"Low-dose RETA significantly reduced tumor volume by 3-fold compared to vehicle, demonstrating efficacy comparable to anti-PD-1 therapy, which achieved a 5-fold reduction in tumor volume"
November 9, 2025 at 10:03 PM
We invented the most powerful weight loss drug ever and it might be an effective oncology drug too 😳🤯
"Low-dose RETA significantly reduced tumor volume by 3-fold compared to vehicle, demonstrating efficacy comparable to anti-PD-1 therapy, which achieved a 5-fold reduction in tumor volume"
"Low-dose RETA significantly reduced tumor volume by 3-fold compared to vehicle, demonstrating efficacy comparable to anti-PD-1 therapy, which achieved a 5-fold reduction in tumor volume"
This is an "oof" result. Triglycerides and acute pancreatitis decreased. *Waves tiny flag*
But increased fatty liver disease and 60%(!!!!) increase in LDL cholesterol. Yikes.
@mikejohansenmd.medsky.social tell me I'm reading this wrong? I don't think I am 😳
But increased fatty liver disease and 60%(!!!!) increase in LDL cholesterol. Yikes.
@mikejohansenmd.medsky.social tell me I'm reading this wrong? I don't think I am 😳
In the CORE-TIMI 72a and CORE2-TIMI 72b phase 3 trials involving patients with severe hypertriglyceridemia, olezarsen led to a significantly greater reduction in the triglyceride level and in acute pancreatitis events than placebo. Full results: nej.md/491XG5V
#AHA25
#AHA25
November 8, 2025 at 3:00 PM
This is an "oof" result. Triglycerides and acute pancreatitis decreased. *Waves tiny flag*
But increased fatty liver disease and 60%(!!!!) increase in LDL cholesterol. Yikes.
@mikejohansenmd.medsky.social tell me I'm reading this wrong? I don't think I am 😳
But increased fatty liver disease and 60%(!!!!) increase in LDL cholesterol. Yikes.
@mikejohansenmd.medsky.social tell me I'm reading this wrong? I don't think I am 😳
I want to believe.
No benefit from GLP1 meds for movement disorders, but in this retrospective cohort there *is* a clear signal for a possible dementia benefit?!
Maybe? Maybe? First RCT on this question should have topline data in the next month or two
No benefit from GLP1 meds for movement disorders, but in this retrospective cohort there *is* a clear signal for a possible dementia benefit?!
Maybe? Maybe? First RCT on this question should have topline data in the next month or two
November 8, 2025 at 12:31 PM
I want to believe.
No benefit from GLP1 meds for movement disorders, but in this retrospective cohort there *is* a clear signal for a possible dementia benefit?!
Maybe? Maybe? First RCT on this question should have topline data in the next month or two
No benefit from GLP1 meds for movement disorders, but in this retrospective cohort there *is* a clear signal for a possible dementia benefit?!
Maybe? Maybe? First RCT on this question should have topline data in the next month or two
Chattanooga Whiskey again with the amazing stuff.
Bourbon x Limecello.
It's like a sour key lime pie in a bottle in the best way. Great way for me and the wifey to relax after a long week for us both
Bourbon x Limecello.
It's like a sour key lime pie in a bottle in the best way. Great way for me and the wifey to relax after a long week for us both
November 8, 2025 at 12:15 AM
Chattanooga Whiskey again with the amazing stuff.
Bourbon x Limecello.
It's like a sour key lime pie in a bottle in the best way. Great way for me and the wifey to relax after a long week for us both
Bourbon x Limecello.
It's like a sour key lime pie in a bottle in the best way. Great way for me and the wifey to relax after a long week for us both
Addendum: The number of visibly and audibly sick people on the plane without a mask kinda sucks. Protect your fellow humans! Please?!
Once again I'll say if you buy a window seat on a plane and then immediately close the window shades on a cloudless autumn day where we're gonna fly over mountains you don't deserve a window seat! Be amazed by the beauty of the world at 30,000 feet!!
November 7, 2025 at 8:12 PM
Addendum: The number of visibly and audibly sick people on the plane without a mask kinda sucks. Protect your fellow humans! Please?!
Once again I'll say if you buy a window seat on a plane and then immediately close the window shades on a cloudless autumn day where we're gonna fly over mountains you don't deserve a window seat! Be amazed by the beauty of the world at 30,000 feet!!
November 7, 2025 at 6:10 PM
Once again I'll say if you buy a window seat on a plane and then immediately close the window shades on a cloudless autumn day where we're gonna fly over mountains you don't deserve a window seat! Be amazed by the beauty of the world at 30,000 feet!!
Last day and literally the last lecture that I attended. Eli Lilly with Mazdutide(GLP1/Glucagon)Phase 2 dose finding study. 16mg dose is not viable. Too many side effects.
But the 10mg dose. Viable. Nearly 20% weight loss without plateau. 20% reduction in LDL cholesterol. Onward to phase 3 now.
But the 10mg dose. Viable. Nearly 20% weight loss without plateau. 20% reduction in LDL cholesterol. Onward to phase 3 now.
November 7, 2025 at 4:06 PM
Last day and literally the last lecture that I attended. Eli Lilly with Mazdutide(GLP1/Glucagon)Phase 2 dose finding study. 16mg dose is not viable. Too many side effects.
But the 10mg dose. Viable. Nearly 20% weight loss without plateau. 20% reduction in LDL cholesterol. Onward to phase 3 now.
But the 10mg dose. Viable. Nearly 20% weight loss without plateau. 20% reduction in LDL cholesterol. Onward to phase 3 now.
Last day in Atlanta and I'm about to treat myself with some pain au chocolat y'all
November 7, 2025 at 1:01 PM
Last day in Atlanta and I'm about to treat myself with some pain au chocolat y'all
Retatrutide does some crazy amazing things.
Congrats Dr E!
Congrats Dr E!
November 6, 2025 at 7:02 PM
Retatrutide does some crazy amazing things.
Congrats Dr E!
Congrats Dr E!
*low whistle* 16-20% weight loss, no plateau at 48 weeks
I'd hate to be working for Novo Nordisk today 😳
I'd hate to be working for Novo Nordisk today 😳
November 6, 2025 at 12:49 PM
*low whistle* 16-20% weight loss, no plateau at 48 weeks
I'd hate to be working for Novo Nordisk today 😳
I'd hate to be working for Novo Nordisk today 😳
Some big Retatrutide news! Triumph 3, which is Retatrutide + existing CVD + severe obesity(BMI>35) has been halted 16 weeks earlier than planned.
Primary endpoint was 80 week weight loss 2nd endpoint was cardiovascular events & was allowed to run for up to 104 weeks for CV event reporting🧵
Primary endpoint was 80 week weight loss 2nd endpoint was cardiovascular events & was allowed to run for up to 104 weeks for CV event reporting🧵
November 6, 2025 at 11:52 AM
Some big Retatrutide news! Triumph 3, which is Retatrutide + existing CVD + severe obesity(BMI>35) has been halted 16 weeks earlier than planned.
Primary endpoint was 80 week weight loss 2nd endpoint was cardiovascular events & was allowed to run for up to 104 weeks for CV event reporting🧵
Primary endpoint was 80 week weight loss 2nd endpoint was cardiovascular events & was allowed to run for up to 104 weeks for CV event reporting🧵
To be more clear on this. Tirzepatide via GIP is insulin sensitizing. Telmisartan is a partial PPAR-Y agonist that also increases insulin sensitivity. Both drug alter lipid levels as well, also probably synergistically. Telmisartan is also a great blood pressure med too.
Ahhh PPAR-GAMMA is synergistic with GIP agonism! All my tirzepatide patients are about to get telmisartan!! Ahhh(sorry nerd moment I had to share, I've suspected this, but apparently it's true*)
*In mice (but should work in humans too)
*In mice (but should work in humans too)
November 6, 2025 at 1:35 AM
To be more clear on this. Tirzepatide via GIP is insulin sensitizing. Telmisartan is a partial PPAR-Y agonist that also increases insulin sensitivity. Both drug alter lipid levels as well, also probably synergistically. Telmisartan is also a great blood pressure med too.
Me: I wonder why Lilly is running trials for orforglipron (oral GLP-1 med) for hypertension??
Sees this slide today at Obesity Week:
OH.
(that placebo reduction is presumably rescue therapy of prescribing traditional blood pressure meds) So yeah impressive reductions.
Sees this slide today at Obesity Week:
OH.
(that placebo reduction is presumably rescue therapy of prescribing traditional blood pressure meds) So yeah impressive reductions.
November 5, 2025 at 9:23 PM
Me: I wonder why Lilly is running trials for orforglipron (oral GLP-1 med) for hypertension??
Sees this slide today at Obesity Week:
OH.
(that placebo reduction is presumably rescue therapy of prescribing traditional blood pressure meds) So yeah impressive reductions.
Sees this slide today at Obesity Week:
OH.
(that placebo reduction is presumably rescue therapy of prescribing traditional blood pressure meds) So yeah impressive reductions.
Ahhh PPAR-GAMMA is synergistic with GIP agonism! All my tirzepatide patients are about to get telmisartan!! Ahhh(sorry nerd moment I had to share, I've suspected this, but apparently it's true*)
*In mice (but should work in humans too)
*In mice (but should work in humans too)
November 5, 2025 at 7:18 PM
Ahhh PPAR-GAMMA is synergistic with GIP agonism! All my tirzepatide patients are about to get telmisartan!! Ahhh(sorry nerd moment I had to share, I've suspected this, but apparently it's true*)
*In mice (but should work in humans too)
*In mice (but should work in humans too)
Maybe it's the nerd in me but this display at the Lilly booth is mesmerizing. It's the 3D structure of all their cardiometabolic molecules in developments. Peptides, small molecules, MABs, and siRNA(the alien tentacles on the top left)
November 5, 2025 at 6:19 PM
Maybe it's the nerd in me but this display at the Lilly booth is mesmerizing. It's the 3D structure of all their cardiometabolic molecules in developments. Peptides, small molecules, MABs, and siRNA(the alien tentacles on the top left)
Just a call out to smart women helping the entire world.
This is Lotte Bjerre Knudsen.
She invented liraglutide and co-invented semaglutide.
She is one of the biggest reasons we have effective anti obesity medications. And her sense of style for this talk is 🤌
This is Lotte Bjerre Knudsen.
She invented liraglutide and co-invented semaglutide.
She is one of the biggest reasons we have effective anti obesity medications. And her sense of style for this talk is 🤌
November 5, 2025 at 2:23 PM
Just a call out to smart women helping the entire world.
This is Lotte Bjerre Knudsen.
She invented liraglutide and co-invented semaglutide.
She is one of the biggest reasons we have effective anti obesity medications. And her sense of style for this talk is 🤌
This is Lotte Bjerre Knudsen.
She invented liraglutide and co-invented semaglutide.
She is one of the biggest reasons we have effective anti obesity medications. And her sense of style for this talk is 🤌
Surreal moment last night. Being questioned by a big pharma science team on glucagon agonism and how to sell it to the general public and especially clinicians who were taught for decades that glucagon and diabetes is bad all because of this blog post I did over the summer:
A Hormone Reformed: The Rise of Glucagon Agonists
The next revolution in medicine arrives in 2026
the-incretins.beehiiv.com
November 5, 2025 at 1:29 PM
Surreal moment last night. Being questioned by a big pharma science team on glucagon agonism and how to sell it to the general public and especially clinicians who were taught for decades that glucagon and diabetes is bad all because of this blog post I did over the summer:
Today's obesity week agenda! More kidney stuff! First talk is by someone who might win a Nobel prize one day(she led the development of liraglutide and then semaglutide, arguably without her we aren't talking GLP1 meds like we do now! Then kidney and CagriSema stuff!
November 5, 2025 at 12:40 PM
Today's obesity week agenda! More kidney stuff! First talk is by someone who might win a Nobel prize one day(she led the development of liraglutide and then semaglutide, arguably without her we aren't talking GLP1 meds like we do now! Then kidney and CagriSema stuff!
While there were a lot of cool displays at Obesity Week this one was really cool. 3D structures of all of Eli Lilly's cardiometabolic molecules in development. They slowly rotated(sorry didn't get video) but very cool to see the differences in small molecule vs peptide vs siRNA drugs
November 5, 2025 at 2:07 AM
While there were a lot of cool displays at Obesity Week this one was really cool. 3D structures of all of Eli Lilly's cardiometabolic molecules in development. They slowly rotated(sorry didn't get video) but very cool to see the differences in small molecule vs peptide vs siRNA drugs
Why do people have trouble losing weight in 2025? Well there's a few reasons. We live in a time of abundance and convenience. We've created an environment where our body's regulators become overwhelmed and we gain weight. #OW2025
November 4, 2025 at 11:21 PM
Why do people have trouble losing weight in 2025? Well there's a few reasons. We live in a time of abundance and convenience. We've created an environment where our body's regulators become overwhelmed and we gain weight. #OW2025
My #OW2025 schedule today, Slightly overbooked but, liver and kidney disease to start then neurobiology, dose de-escalation for maintenance, then NA-931(which is a scam/fake drug?!! More on that later) and finally finish with cancer and obesity and finish with poster session.
November 4, 2025 at 2:28 PM
My #OW2025 schedule today, Slightly overbooked but, liver and kidney disease to start then neurobiology, dose de-escalation for maintenance, then NA-931(which is a scam/fake drug?!! More on that later) and finally finish with cancer and obesity and finish with poster session.