Is creatinine a better monitoring choice than cystatin C on survodutide?

Setup, so nobody has to ask: creatinine · cystatin C · survodutide.

I suspect the honest answer is that it depends, in which case I would like to know on what.

Assume I can obtain either option without difficulty, so availability is not the deciding factor.

What is the actual trade-off, and does it matter at the scale I am working at?

This is a question about what the trial was designed to answer, and the honest response is that it was not designed to answer this.

The rodent thyroid C-cell findings that generated the labelled warning appear to be species-specific: rodent C-cells express GLP-1 receptors at high density, human C-cells at very low density, and human calcitonin data across large trial populations has not reproduced the signal. A family history of medullary thyroid carcinoma or MEN2 is nonetheless a genuine contraindication rather than a theoretical one.

A network meta-analysis can rank agents that were never compared directly, but only under a transitivity assumption — that the trials being linked are similar enough in population, duration and endpoint definition for the indirect comparison to hold. In this field that assumption is often visibly violated, which is why indirect rankings should be read as hypotheses.

STEP 1 reported a mean weight change of approximately −14.9 per cent with semaglutide 2.4 mg versus −2.4 per cent with placebo at 68 weeks[1]; the difference between the figures quoted from this trial in different places is an estimand difference.

None of this replaces a clinician who can see the whole picture, and the whole picture is usually where the answer is.