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The most significant monitoring requirements for patients with acquired hypothalamic obesity starting setmelanotide are: (1) patients who also have secondary adrenal insufficiency a common comorbidity faced a 5% rate of serious acute adrenal insufficiency events in TRANSCEND, versus none on placebo, and require active monitoring during illness or physiological stress

4 units = 200 mcg

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Rather than acting through a single pathway, these agents exert coordinated effects across several levels of vascular regulation