{
  "schema_version": "1.0",
  "scoring_notes": "ESMO-MCBS analog for obesity. Composite 0-10 score. Components weighted as: weight_loss (3.0), MACE prevention (1.5), T2DM prevention (1.5), MASLD remission (1.0), HFpEF symptom (1.0), fracture safety (0.5), sarcopenia/lean-mass safety (1.0), persistence/discontinuation penalty (0.5). Higher = better.",
  "discontinuation_RWE_1yr": {
    "GLP-1RA_obesity_indication_pct": 42,
    "GLP-1RA_T2DM_indication_pct": 28,
    "STEP-4_drug_off_regain_1yr_pct": 67,
    "SURMOUNT-4_drug_off_regain_1yr_pct": 14,
    "notes": "Drug-off regain trajectory: tirzepatide ~14% (SURMOUNT-4), semaglutide ~67% (STEP-4) at 1 year"
  },
  "drugs": [
    {"drug_id": "tirzepatide_15mg", "weight_loss_subscore": 2.9, "MACE_subscore": 1.3, "T2DM_subscore": 1.4, "MASLD_subscore": 0.9, "HFpEF_subscore": 0.9, "fracture_subscore": 0.4, "sarcopenia_subscore": 0.5, "persistence_penalty": -0.3, "total_score": 8.0, "label": "high"},
    {"drug_id": "semaglutide_2.4mg", "weight_loss_subscore": 2.4, "MACE_subscore": 1.2, "T2DM_subscore": 1.3, "MASLD_subscore": 0.8, "HFpEF_subscore": 0.8, "fracture_subscore": 0.4, "sarcopenia_subscore": 0.4, "persistence_penalty": -0.5, "total_score": 6.8, "label": "high"},
    {"drug_id": "retatrutide", "weight_loss_subscore": 3.0, "MACE_subscore": null, "T2DM_subscore": null, "MASLD_subscore": null, "HFpEF_subscore": null, "fracture_subscore": null, "sarcopenia_subscore": null, "persistence_penalty": null, "total_score": null, "label": "pending phase 3"},
    {"drug_id": "survodutide", "weight_loss_subscore": 2.5, "MACE_subscore": null, "T2DM_subscore": null, "MASLD_subscore": 1.0, "HFpEF_subscore": null, "fracture_subscore": null, "sarcopenia_subscore": 0.7, "persistence_penalty": null, "total_score": null, "label": "pending phase 3 (MASLD lead)"},
    {"drug_id": "CagriSema", "weight_loss_subscore": 2.9, "MACE_subscore": null, "T2DM_subscore": null, "MASLD_subscore": null, "HFpEF_subscore": null, "fracture_subscore": null, "sarcopenia_subscore": 0.8, "persistence_penalty": null, "total_score": null, "label": "pending"},
    {"drug_id": "MariTide", "weight_loss_subscore": 2.5, "MACE_subscore": null, "T2DM_subscore": null, "MASLD_subscore": null, "HFpEF_subscore": null, "fracture_subscore": null, "sarcopenia_subscore": null, "persistence_penalty": 0.3, "total_score": null, "label": "pending (monthly dosing may improve persistence)"},
    {"drug_id": "orforglipron", "weight_loss_subscore": 2.0, "MACE_subscore": null, "T2DM_subscore": null, "MASLD_subscore": null, "HFpEF_subscore": null, "fracture_subscore": null, "sarcopenia_subscore": null, "persistence_penalty": 0.2, "total_score": null, "label": "pending (oral may improve persistence)"},
    {"drug_id": "amycretin", "weight_loss_subscore": 2.8, "MACE_subscore": null, "T2DM_subscore": null, "MASLD_subscore": null, "HFpEF_subscore": null, "fracture_subscore": null, "sarcopenia_subscore": null, "persistence_penalty": null, "total_score": null, "label": "pending phase 2"},
    {"drug_id": "liraglutide_3.0mg", "weight_loss_subscore": 1.3, "MACE_subscore": 0.9, "T2DM_subscore": 1.2, "MASLD_subscore": 0.5, "HFpEF_subscore": 0.5, "fracture_subscore": 0.4, "sarcopenia_subscore": 0.3, "persistence_penalty": -0.7, "total_score": 4.4, "label": "moderate"},
    {"drug_id": "setmelanotide", "weight_loss_subscore": 2.7, "MACE_subscore": null, "T2DM_subscore": null, "MASLD_subscore": null, "HFpEF_subscore": null, "fracture_subscore": null, "sarcopenia_subscore": 0.3, "persistence_penalty": -0.4, "total_score": 2.6, "label": "niche (rare genetic only)"},
    {"drug_id": "naltrexone_bupropion", "weight_loss_subscore": 0.8, "MACE_subscore": 0.6, "T2DM_subscore": 1.0, "MASLD_subscore": 0.3, "HFpEF_subscore": 0.1, "fracture_subscore": 0.4, "sarcopenia_subscore": 0.5, "persistence_penalty": -0.6, "total_score": 3.1, "label": "low"},
    {"drug_id": "phentermine", "weight_loss_subscore": 0.9, "MACE_subscore": null, "T2DM_subscore": null, "MASLD_subscore": null, "HFpEF_subscore": null, "fracture_subscore": 0.4, "sarcopenia_subscore": 0.4, "persistence_penalty": -0.5, "total_score": 1.2, "label": "low (short-term only)"},
    {"drug_id": "orlistat", "weight_loss_subscore": 0.5, "MACE_subscore": 0.5, "T2DM_subscore": 0.9, "MASLD_subscore": 0.4, "HFpEF_subscore": 0.1, "fracture_subscore": 0.4, "sarcopenia_subscore": 0.5, "persistence_penalty": -0.8, "total_score": 2.5, "label": "low"}
  ]
}