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Hemmingsen B, Christensen LL, Wetterslev J, Vaag A, Gluud C, Lund SS, Almdal T

The effects of weight loss on imaging outcomes in osteoarthritis of the hip or knee in people who are overweight or obese: a systematic review

Effect of L-carnitine and acetyl-L-carnitine on human erythrocyte membrane stability and deformability

And this often is a form factor as you outlined or it could be dosing dynamics of a patient is not getting the outcome that theyre hoping for, are they experiencing side effects that are intolerable