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Gastric electrical stimulation (the Enterra device) is FDA-approved under humanitarian device exemption but shows mixed results in clinical trials (McCallum et al., Gastroenterology, 2010)
If disease activity remains inadequately controlled, treatment should escalate to combination conventional synthetic DMARDs or biological agents following a treat-to-target approach
Effects of metformin on the gut microbiota in obesity and type 2 diabetes mellitus
drugs that hitchhike on it stay in circulation far longer
Both medications accumulate to steady state within 3-4 weeks of consistent weekly injections, though tirzepatide's slightly shorter half-life means it clears more rapidly if doses are delayed
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