Every peptide, graded on the evidence.
152 compounds, from approved drugs to grey-market vials. Each one says what it is sold for, what the published studies support, and where the FDA stands as of 2026-10-27.
- CNot approved5-Amino-1MQSmall-molecule NNMT inhibitor
Two mouse studies show reduced fat mass and better glucose handling in diet-induced obese animals, but no human data exist, so the fat-loss claim rests entirely on preclinical work (grade C).
- AFDA approvedAbaloparatidePTHrP analog
A large randomized trial showed fewer new spine and non-spine fractures over 18 months compared with placebo, which meets the bar for grade A for postmenopausal osteoporosis.
- BCosmeticAcetyl hexapeptide-8Neurotransmitter-inhibiting peptide
One small randomized trial found a measurable reduction in eye-area wrinkles and another found none, while penetration studies show almost none of the peptide reaches the muscle layer, so the evidence supports a modest surface effect at best (grade B).
- CCosmeticAcetyl octapeptide-3Neurotransmitter-inhibiting peptide
The mechanism is borrowed from Argireline and the clinical support is one randomized cosmetic study plus manufacturer tests, which is too little to say it reduces wrinkles (grade C).
- DCosmeticAcetyl tetrapeptide-5Signal peptide
There is no published, peer-reviewed evidence for any effect; the supporting data are the manufacturer's own tests (grade D).
- AFDA approvedAfamelanotideMC1R agonist
Randomized trials show it lengthens the time EPP patients can spend in sunlight without pain, which earns grade A for that indication; there are no trials supporting cosmetic tanning.
- AFDA approvedAlbiglutideGLP-1 receptor agonist
Large randomized trials showed it lowered blood glucose and cut major cardiovascular events by about a fifth in people with type 2 diabetes and heart disease, which is grade A evidence for a drug nobody can buy.
- BIn trialsAmycretinAmylin + GLP-1 co-agonist
Early randomized trials show large, dose-dependent weight loss over up to 36 weeks with the usual gastrointestinal side effects, but the trials were small and many participants dropped out, so the evidence is grade B pending phase 3.
- AFDA approvedAngiotensin IIVasopressor peptide
A 344-patient randomized trial showed it raises blood pressure in shock patients who are not responding to other vasopressors, which earned approval, but it did not show that patients live longer.
- CNot approvedAOD-9604GH fragment (lipolytic)
Mouse studies showed increased fat breakdown, but the one sizeable human obesity programme failed to show weight loss and was abandoned, so the fat-loss claim rests on animal data (grade C).
- BIn trialsApraglutideGLP-2 analog
One 163-patient randomized trial showed a larger reduction in weekly intravenous nutrition volume than placebo over 24 weeks, with a clearer effect in patients with a stoma than in those with colon in continuity (grade B).
- BIn trialsAviptadilVasoactive intestinal peptide
A randomized trial of roughly 460 critically ill COVID-19 patients found no benefit on recovery or survival, so the respiratory claim is not supported despite a plausible mechanism (grade B, negative).
- BFDA approvedBacitracinPolypeptide antibiotic
In a 922-patient randomized trial, wounds treated with bacitracin got infected at the same low rate as wounds treated with plain petroleum jelly, and bacitracin caused allergic reactions that petrolatum did not (grade B).
- BIn trialsBalixafortideCXCR4 antagonist peptide
An encouraging uncontrolled early trial was followed by a 432-patient randomized trial that showed no benefit when balixafortide was added to eribulin (grade B, negative).
- AFDA approvedBivalirudinDirect thrombin inhibitor
In a 3,602-patient randomized trial of heart attack patients undergoing stenting, bivalirudin reduced major bleeding and 30-day cardiac death compared with heparin plus a platelet blocker, at the cost of more stent thrombosis in the first 24 hours (grade A).
- CNot approvedBPC-157Synthetic pentadecapeptide (gastric-derived)
Dozens of rat studies, nearly all from one laboratory, show faster tendon, ligament and gut healing, but the only human data are a 12-patient uncontrolled series, so nothing is established in people (grade C).
- BFDA approvedBremelanotideMC4R agonist
Two randomized trials in 1,267 women showed statistically significant but small improvements in questionnaire scores for desire and distress, no increase in satisfying sexual events, and nausea in about 40% of users (grade B).
- CIn trialsBrilacidinDefensin-mimetic host-defense peptide
Cell-culture studies show it disrupts viral particles and infected cells at low concentrations, but no peer-reviewed human trial has been published for any use (grade C).
- BIn trialsCagrilintideLong-acting amylin analog
Randomized trials show cagrilintide alone produces about 6% to 11% weight loss at 26 weeks depending on dose, and with semaglutide about 20% at 68 weeks, with mainly gastrointestinal side effects (grade B pending standalone phase 3).
- AIn trialsCagriSemaAmylin + GLP-1 combination
Published phase 3 trials show roughly 20% body-weight loss over 68 weeks against 3% on placebo, which earns an A for the weight-loss use, but the head-to-head trial against tirzepatide missed its primary goal.
- BFDA approvedCalcitonin-salmonCalcitonin receptor agonist
One large trial showed a vertebral-fracture reduction at a single dose level with an inconsistent dose response, regulators in Europe pulled the osteoporosis indication over a small cancer signal, and the FDA label now says fracture benefit is not established, so the evidence sits at B.
- CCosmeticCarnosineAntioxidant dipeptide
Lab models of human skin show carnosine lowers oxidative stress markers after UV exposure, but nobody has shown a visible benefit in a controlled trial on people, so the evidence is C.
- BNot approvedCerebrolysinNeuropeptide preparation (porcine brain)
Randomized trials exist, which earns a B, but the largest independent synthesis found no effect on death or dependence after stroke and a rise in serious adverse events, while smaller manufacturer-backed trials found small functional gains.
- AFDA approvedCetrorelixGnRH antagonist
Dozens of randomized trials show GnRH antagonist protocols give the same live-birth rate as agonist protocols with fewer cases of ovarian hyperstimulation, which supports an A for the fertility use.
- BNot approvedCJC-1295GHRH analog (secretagogue)
Small trials in healthy volunteers confirm that it raises GH and IGF-1 for a week or more per injection, which is a real pharmacological effect measured on blood tests, but no study has shown it changes body composition or any health outcome.
- CCosmeticCopper tripeptide-1Carrier/copper peptide
Cell and animal studies show it switches on repair genes and speeds wound closure, but the one blinded human trial found no measurable skin benefit over the control regimen, so the evidence is C.
- BFDA approvedCorticotropinMelanocortin / ACTH
In infantile spasms, a small randomized trial found high-dose corticotropin stopped spasms and normalized the EEG in 87% of infants against 29% on prednisone, which supports that use; for most other labeled conditions the evidence is old and uncontrolled.
- AFDA approvedCosyntropinACTH(1-24) analog
Pooled data from 679 patients show the cosyntropin stimulation test reliably separates adrenal insufficiency from normal function, which supports an A for its diagnostic use.
- AFDA approvedCyclosporineCyclic peptide immunosuppressant
A randomized trial in 1983 showed a 16-percentage-point gain in one-year kidney graft survival, and the drug's approval and decades of use rest on that class of evidence, which is an A.
- AFDA approvedDalbavancin / Oritavancin / TelavancinLipoglycopeptide antibiotics
Large randomized trials show once-weekly dalbavancin and single-dose oritavancin match daily vancomycin for skin infections, and telavancin is non-inferior for skin infections and pneumonia, which supports an A for the approved uses.
- AFDA approvedDaptomycinCyclic lipopeptide antibiotic
A 246-patient randomized trial showed daptomycin cures S. aureus bacteremia and right-sided endocarditis about as often as standard therapy with less kidney damage, which with the skin-infection trials behind its approval supports an A.
- AFDA approvedDasiglucagonGlucagon analog
A 170-person randomized trial showed glucose recovered within 10 minutes in half the participants and within 15 minutes in 99%, matching conventional glucagon, which supports an A for the approved rescue use.
- BIn trialsDavunetideNeuroprotective peptide
The one phase 3 trial, 313 patients over a year, found davunetide no better than placebo on movement or daily-function scores in progressive supranuclear palsy, so the human evidence is a well-conducted negative result.
- AFDA approvedDegarelixGnRH antagonist
A 610-man randomized trial showed degarelix matches leuprolide at suppressing testosterone over a year and gets there faster, which with approval supports an A.
- AFDA approvedDesirudinDirect thrombin inhibitor
A 2,079-patient randomized trial showed desirudin prevented more clots after hip replacement than enoxaparin with similar bleeding, which earns an A for the approved use even though the product is no longer sold.
- AFDA approvedDesmopressinVasopressin V2 analog
Approval for diabetes insipidus, bleeding disorders and nocturia rests on controlled trials and decades of use, an A for those indications, while the only consistent safety story is dangerously low sodium when fluid intake is not restricted.
- AFDA approvedDifelikefalinKappa-opioid agonist peptide
Two placebo-controlled trials in dialysis patients support the approved use, so the grade is A for uremic pruritus and nothing else.
- CNot approvedDihexaAngiotensin IV-derived peptide
A handful of rodent studies, two of them now retracted, show reversal of drug-induced memory deficits; there is no human data at all, so the grade is C.
- DCosmeticDipeptide diaminobutyroyl benzylamide diacetateNeuromuscular-relaxing peptide
The only human evidence is manufacturer testing and a combination-product study, which is a D on our scale.
- CNot approvedDSIPNeuromodulatory nonapeptide
Small, old human studies with mixed results and no modern trial, so the grade is C.
- AFDA approvedDulaglutideGLP-1 receptor agonist
Large randomized trials support the diabetes and cardiovascular indications, which earns an A for those uses; weight loss is a side effect of a few kilograms, not a tested indication.
- AFDA approvedEcallantidePlasma kallikrein inhibitor
Two placebo-controlled trials support the approved use, so the grade is A, with the caveat that about 4% of treated patients in trials had anaphylaxis.
- AFDA approvedEchinocandinsLipopeptide antifungals
Randomized trials showed each echinocandin at least as effective as amphotericin B or fluconazole with fewer toxic effects, which is an A for invasive candidiasis.
- BIn trialsEfpeglenatideLong-acting GLP-1 agonist
A single 4,076-patient outcomes trial showed cardiovascular and kidney benefit comparable to approved GLP-1 drugs, which is strong but orphaned evidence, hence B.
- BIn trialsElamipretideMitochondria-targeting tetrapeptide
A tiny crossover trial plus open-label follow-up earned a conditional approval in Barth syndrome, while the one large randomized trial in mitochondrial myopathy was negative, which lands at B for the approved use and lower for everything else.
- AFDA approvedEnfuvirtideHIV fusion inhibitor peptide
Two randomized trials in multidrug-resistant HIV showed clear virologic benefit, an A for its approved use, though newer oral and long-acting drugs have made it obsolete.
- AFDA approvedEnlicitideOral macrocyclic PCSK9 inhibitor peptide
Multiple large placebo-controlled trials show LDL reductions of 56 to 59%, with no event-reduction data yet, which is an A for LDL lowering.
- CNot approvedEpitalonPineal tetrapeptide (Ala-Glu-Asp-Gly)
Animal and cell studies from a single research school plus one weak human study of a different preparation put this at C.
- AFDA approvedEptifibatideGPIIb/IIIa inhibitor
A 10,948-patient placebo-controlled trial showed a modest reduction in death or heart attack with more bleeding, which is an A for its approved use.
- AFDA approvedEtelcalcetideCalcimimetic peptide
Three randomized trials show it lowers parathyroid hormone more than placebo and more than oral cinacalcet, an A for the approved biochemical indication.
- AFDA approvedExenatideGLP-1 receptor agonist
Randomized trials support its use in type 2 diabetes, an A for that indication, while for weight loss it is a weak relative of the drugs that replaced it.
- CNot approvedFollistatin-344Myostatin-inhibiting peptide
Two six-patient gene therapy trials and myostatin-knockout mice are the whole evidence base, and none of it involves injecting the protein, so the grade is C.
- CNot approvedFragment 176-191GH C-terminal fragment
Rodent studies support a fat-mobilizing effect, and the human obesity trials run under the name AOD9604 failed, which puts it at C.
- BFDA approvedGa-68 dotatateSSTR imaging radiopeptide
Head-to-head imaging studies show higher accuracy than the older scan and frequent changes in management, which supports its approved diagnostic use at a B.
- AFDA approvedGanirelixGnRH antagonist
Randomized trials show pregnancy rates similar to the older leuprolide protocol with fewer injections, an A for its approved use.
- CNot approvedGHK-CuCopper-binding tripeptide
Cell and animal work shows that GHK-Cu raises collagen production and speeds wound closure in rats, but the human evidence is limited to cosmetic tests reported inside reviews, which is why the grade is C.
- CNot approvedGHRP-2GHRP / ghrelin agonist
In small human studies GHRP-2 does release growth hormone and increases appetite, but repeated dosing attenuates the response without raising IGF-1, and no trial has measured a body-composition or health outcome, so the grade is C.
- CNot approvedGHRP-6GHRP / ghrelin agonist
A single dose of GHRP-6 does release growth hormone in healthy men, but there is no human trial measuring muscle, fat or recovery, and the heart findings are from rodents, which is the C grade.
- BIn trialsGlepaglutideGLP-2 analog
The phase 3 trial showed that glepaglutide at the trial dose cut parenteral support volume per week more than placebo, a real but single-trial result that regulators have not yet accepted, which is grade B.
- AFDA approvedGlucagonGlucagon receptor agonist
Randomised trials show that nasal and ready-to-use glucagon raise blood glucose as reliably as the injected kit within minutes, supporting the approvals and the A grade.
- BNot approvedGlutathioneAntioxidant tripeptide
Oral glutathione does raise body stores and produced a modest, site-specific lightening in one small trial, while inhaled glutathione failed in cystic fibrosis and intravenous glutathione showed no clear benefit in a Parkinson's pilot, so the grade is B for the skin claim and lower for the others.
- CNot approvedGonadorelin (compounded)GnRH (native)
Pulsatile GnRH works in men whose pituitary is intact but unstimulated, but no trial has tested intermittent gonadorelin injections in men on testosterone therapy, so the grade is C.
- AFDA approvedGoserelinGnRH agonist
Randomised trials show goserelin lowers sex hormones to post-menopausal or castrate levels and matches chemotherapy for survival in hormone-sensitive premenopausal breast cancer, which supports the approvals and the A grade.
- CCosmeticHexapeptide-9Signal peptide
The only controlled human trial tested a modified molecule and was run by the manufacturer, and the data for standard hexapeptide-9 are laboratory assays, so the grade is C.
- CNot approvedHexarelinGHRP / ghrelin agonist
Hexarelin produces a larger growth hormone pulse than GHRH in healthy adults but also raises cortisol and prolactin, and its cardiac effects have been shown only in animals, so the grade is C.
- BFDA approvedHistrelinGnRH agonist
A 36-child open-label trial showed the implant suppressed puberty hormones in every child for a year, which supports the approval, though no randomised comparison against monthly injections exists.
- AFDA approvedHuman chorionic gonadotropinGlycoprotein gonadotropin
Randomised trials support hCG for ovulation triggering and for raising testosterone in hypogonadal men, which earns the A grade for those uses; the weight-loss claim has no trial support and the FDA has said so.
- CNot approvedHumaninMitochondrial-derived peptide
Humanin protects neurons and improves insulin action in animals and tracks with age and disease in human blood samples, but it has never been administered to people in a trial, which is grade C.
- AFDA approvedIcatibantBradykinin B2 antagonist
Placebo-controlled trials show icatibant shortens attacks from about 20 hours to about 2 hours, which supports the approval and the A grade.
- CNot approvedIGF-1 DESIGF-1 analog
Cell studies explain why des(1-3)IGF-1 is more potent than IGF-1 in a dish, but there are no human studies at all, so the grade is C.
- CNot approvedIGF-1 LR3IGF-1 analog
IGF-1 LR3 is a well characterised laboratory reagent that activates the IGF-1 receptor in cell culture, but it has never been studied in humans, so the grade is C.
- AFDA approvedInsulin analogsInsulin receptor agonist
Randomised trials show analogs match human insulin on blood glucose and reduce hypoglycaemia, particularly at night, which is the basis of their approvals and the A grade.
- CNot approvedIpamorelinGHRP / ghrelin receptor agonist
Ipamorelin releases growth hormone in humans without the cortisol rise seen with GHRP-2 and GHRP-6, but the only outcome trial, in bowel surgery patients, was negative, and no study has measured body composition or aging, so the grade is C.
- BNot approvedKisspeptin-10Reproductive peptide
In small controlled trials kisspeptin raises luteinising hormone and testosterone and increases sexual brain responses, with the largest trial in 32 men, which earns a B; online products are the 10-amino-acid fragment, while most of the trial evidence used kisspeptin-54.
- CNot approvedKPVAnti-inflammatory tripeptide
KPV reduces colitis in mice when given systemically or in oral nanoparticles, but there is no human data at all, so the grade is C.
- AFDA approvedLanreotideSomatostatin analog
A placebo-controlled trial in 204 patients and the acromegaly trials behind the label support both approved uses, which is why it grades A.
- BIn trialsLarazotide acetateZonulin antagonist (tight-junction regulator)
Randomized trials in celiac patients were run and pooled, but the phase 3 was stopped for lack of effect, so the controlled human evidence (grade B) does not support the claimed benefit.
- AFDA approvedLeuprolideGnRH agonist
Controlled trials and 40 years of clinical use support the approved indications, so it grades A for prostate cancer and precocious puberty.
- AFDA approvedLinaclotideGuanylate cyclase-C agonist
Multiple large randomized placebo-controlled trials met their FDA-set endpoints, which is why it grades A.
- AFDA approvedLiraglutideGLP-1 receptor agonist
Trials in nearly 10,000 diabetic patients and 3,700 adults with obesity showed fewer heart events and about 8 percent body weight loss respectively, which earns an A for both approved uses.
- AFDA approvedLixisenatideGLP-1 receptor agonist
Phase 3 glycemic trials and a 6,068-patient cardiovascular trial support its approval for type 2 diabetes (grade A), with the cardiovascular trial showing neither harm nor benefit.
- CNot approvedLL-37Host-defense antimicrobial peptide
Topical LL-37 has two small wound-healing trials with mixed results, the body's own LL-37 is well studied and drives inflammation in psoriasis and rosacea, and there are no human data on injecting it, so the evidence for the marketed use is grade C.
- CIn trialsLTX-315Oncolytic peptide
A 39-patient uncontrolled phase 1 trial showed injected tumors regressing in some patients and immune cells moving in, which is grade C evidence until a controlled trial reports.
- AFDA approvedLutetium Lu-177 dotatateSSTR-targeted radiopeptide
A 229-patient randomized trial showed a 79 percent reduction in progression or death versus octreotide, which supports an A grade for its approved use.
- AFDA approvedLutetium Lu-177 vipivotide tetraxetanPSMA-targeted radioligand
An 831-patient randomized trial showed a four-month survival gain, and further randomized trials supported earlier use, which is an A for its approved indications.
- AIn trialsMazdutideGLP-1 / glucagon dual agonist
Two phase 3 trials in more than a thousand Chinese adults produced about 15 percent weight loss versus placebo over 48 to 60 weeks and led to approval in China, which grades A, although no US trial has finished and no outcomes trial exists.
- BFDA approvedMecaserminIGF-1 (recombinant)
Uncontrolled follow-up of 76 children with IGF-1 deficiency showed growth velocity roughly tripling in the first year, enough for approval in a rare disease but not for an A, and there are no trials for any other use.
- CNot approvedMechano growth factorIGF-1 splice variant
Exercise raises MGF expression in young muscle and the E-domain peptide activates muscle stem cells in a dish, but no one has published a trial of injecting it into people, so the evidence is grade C.
- BNot approvedMelanotan IMC1R agonist
A 65-person placebo-controlled trial showed more melanin and less UV damage in fair skin, and two trials in 168 porphyria patients led to approval of the implant, so the evidence is grade B for tanning and the approved product is a different formulation for a rare disease.
- CNot approvedMelanotan IIMelanocortin agonist (MC1R/MC3R/MC4R)
A three-man pilot study in 1996 showed it darkens skin and causes erections and nausea, and the rest of the literature is case reports of harm, which is grade C evidence.
- BNot approvedMK-677 (ibutamoren)Non-peptide ghrelin mimetic
Controlled trials confirm it raises growth hormone and IGF-1, but the body composition change in 65 older adults was small, strength did not improve, blood sugar rose, and a 563-patient Alzheimer's trial failed, so the evidence is grade B.
- AFDA approvedMotixafortideCXCR4 antagonist peptide
A 122-patient placebo-controlled trial showed 92.5 percent versus 26 percent of patients reaching the stem cell target in up to two collections, which is enough for an A for this single approved use.
- CNot approvedMOTS-cMitochondrial-derived peptide
Mice given MOTS-c resisted obesity and ran longer, and humans make more of it after exercise, but no trial has given it to people, so the evidence is grade C.
- CIn trialsMurepavadinAntimicrobial 'protegrin' peptidomimetic
Phase 1 and small phase 2 data showed it reaches the blood and clears Pseudomonas in small uncontrolled series, but the phase 3 trials were stopped for kidney injury, leaving grade C evidence.
- AFDA approvedNafarelinGnRH agonist
Randomized trials showed nafarelin shrank endometriosis lesions and relieved pain about as well as danazol, with a different side effect profile, which is the basis of its approval and its A grade.
- BIn trialsNangibotideTREM-1 inhibitor peptide
A single controlled trial missed its primary endpoint, with a post hoc hint of benefit in patients with high soluble TREM-1 levels, which is enough for B but not for a claim that it works.
- BFDA approvedNesiritideNatriuretic peptide
The largest heart failure drug trial of its era showed nesiritide neither helped nor clearly harmed, which is why its use faded and its approval is now mostly of historical interest.
- CIn trialsNNZ-2591IGF-1-related peptide
One small uncontrolled trial found the drug was tolerated and that scores moved in a favorable direction, which is the kind of evidence that justifies a placebo-controlled trial but does not show the drug works.
- CCosmeticNonapeptide-1Brightening peptide
Cell and receptor studies show it competes with alpha-MSH at the MC1R receptor, but no published human trial shows it lightens skin, so the grade is C.
- AFDA approvedOctreotideSomatostatin analog
Controlled trials show octreotide lowers growth hormone in acromegaly, controls carcinoid symptoms, and slows the growth of midgut neuroendocrine tumors, supporting an A grade for its approved uses.
- CCosmeticOligopeptide-1Growth-factor peptide
EGF has a well-understood role in wound healing, but the cosmetic evidence is a handful of small, short, uncontrolled or industry-run studies, which is C-grade support.
- AFDA approvedOxytocinOxytocin receptor agonist
The childbirth uses are solidly proven, which earns the A, but randomized trials of intranasal oxytocin for psychiatric and pain conditions have mostly come back null or mixed.
- CCosmeticPalmitoyl hexapeptide-12Signal peptide
The published evidence shows the peptide penetrates skin and interacts with its structural molecules in the laboratory; whether that changes how skin looks has not been tested in a published human trial.
- BCosmeticPalmitoyl pentapeptide-4Signal (collagen) peptide
A single sponsor-run randomized trial found modest wrinkle improvement versus the same moisturizer without the peptide, which is better evidence than most cosmetic peptides have and still short of independent confirmation.
- DCosmeticPalmitoyl tetrapeptide-7Signal / anti-inflammatory peptide
The published record is a safety review and nothing on efficacy, so the claims rest on manufacturer data and the grade is D.
- DCosmeticPalmitoyl tripeptide-1Signal peptide
Published data cover safety only; the wrinkle claims rest on unpublished manufacturer testing of a blend, which is a D.
- CCosmeticPalmitoyl tripeptide-38Signal peptide
The only published human study is uncontrolled and tests a combination serum, so improvement cannot be attributed to the peptide; the vehicle-controlled data are the manufacturer's.
- AFDA approvedPalopegteriparatideLong-acting PTH prodrug
A placebo-controlled phase 3 trial showed about four in five patients reached normal calcium without conventional supplements, versus one in twenty on placebo, which is A-grade support for the approved use.
- AFDA approvedParathyroid hormonePTH (recombinant)
A 24-week placebo-controlled trial showed about half of patients could cut their supplements by half or more while keeping calcium normal, supporting the approval; supply problems ended the product, and efficacy was not the cause.
- AFDA approvedPasireotideSomatostatin analog
In the phase 3 trial about one in four patients at the higher trial dose reached normal cortisol at six months, and most developed high blood sugar, which is an approvable but limited result.
- AFDA approvedPegcetacoplanComplement C3 inhibitor (PEG peptide)
In a head-to-head trial it outperformed the previous standard drug on hemoglobin in PNH, and a placebo-controlled trial showed a large reduction in urinary protein in two rare kidney diseases, which supports an A for the approved uses.
- AFDA approvedPegvisomantGH receptor antagonist
A placebo-controlled trial normalized IGF-1 in nearly nine out of ten patients at the top trial dose, with symptom relief tracking the biochemistry, which is A-grade evidence for its approved use.
- BIn trialsPemvidutideGLP-1 / glucagon dual agonist
Phase 2 trials show large reductions in liver fat and resolution of MASH in about half of treated patients versus a fifth on placebo, with moderate weight loss, which is B-grade evidence pending a confirmatory trial.
- DCosmeticPentapeptide-18Neurotransmitter-inhibiting peptide
There is no independent published human study of pentapeptide-18; what exists is the maker's description of its mechanism and a manufacturer-run wrinkle test, which is why it sits at grade D.
- BIn trialsPetrelintideLong-acting amylin analog
One published phase 2 trial shows about a tenth of body weight lost over 42 weeks with gastrointestinal tolerability close to placebo apart from mild nausea, which earns a B; the phase 3 program that would settle efficacy and safety is only starting.
- AFDA approvedPlecanatideGuanylate cyclase-C agonist
Large randomized trials show plecanatide roughly doubles the chance of a durable improvement in bowel movements compared with placebo, with diarrhea as the main side effect, which earns an A for its approved use.
- CIn trialsPN-943Oral α4β7 integrin antagonist peptide
The one controlled trial in ulcerative colitis failed its primary endpoint at the higher dose and showed only a borderline signal at the lower one, so the evidence does not support the claimed use.
- BFDA approvedPolymyxin B / ColistinPolymyxin antibiotic
The polymyxins kill multidrug-resistant Gram-negative bacteria and remain in use for lack of alternatives, but their approvals predate controlled trials and the one large RCT showed that adding meropenem does not improve outcomes.
- AFDA approvedPramlintideAmylin analog
Randomized trials show pramlintide modestly lowers HbA1c and body weight when added to insulin, at the cost of nausea and a higher risk of insulin-related hypoglycemia, which supports its narrow approved use.
- BNot approvedPT-141MC4R agonist
Two phase 3 trials support a modest effect on sexual desire in premenopausal women with HSDD, which is what the FDA approved; the evidence in men is two small, abandoned nasal-spray studies from 2004, and nausea affects about 40 percent of users.
- BIn trialsRetatrutideTriple GLP-1 / GIP / glucagon agonist
Randomized trials show about a quarter of body weight lost over 48 weeks and roughly a fifth over 80 weeks in people with diabetes, with gastrointestinal side effects and heart rate increases, which supports a B pending approval and full phase 3 publication.
- AFDA approvedRusfertideHepcidin mimetic peptide
Two randomized trials show rusfertide keeps hematocrit below 45 percent and frees most patients from phlebotomy, with injection site reactions as the main side effect, which earns an A for its approved use.
- BFDA approvedSecretinSecretin hormone
Secretin dependably stimulates pancreatic fluid and gastrin release, which is what its diagnostic approval requires; the randomized trial of secretin for autism found no benefit over placebo.
- BNot approvedSelankAnxiolytic peptide (Russian)
A single 62-patient Russian trial found anxiety relief comparable to a benzodiazepine, and animal work points to GABA and NMDA receptor effects, but there is no placebo-controlled human trial, so the claims rest on thin evidence.
- CIn trialsSelepressinSelective vasopressin V1a agonist
The one large randomized trial found selepressin did not increase ventilator- and vasopressor-free days or reduce mortality compared with placebo, so the evidence does not support it.
- AFDA approvedSemaglutideGLP-1 receptor agonist
Randomized trials in tens of thousands of people show about 15 percent weight loss, roughly a 1 to 2 point HbA1c reduction, a 20 percent cut in major cardiovascular events and slower kidney decline, with gastrointestinal side effects and weight regain after stopping as the main caveats.
- BNot approvedSemaxNootropic peptide (ACTH(4-10) analog)
Russian clinical studies report faster recovery after stroke and fewer vascular events in chronic cerebrovascular disease, and a small imaging study shows it changes brain network activity in healthy people, but no blinded placebo-controlled trial has been published, so the cognitive claims are unproven.
- CNot approvedSermorelinGHRH analog (secretagogue)
Sermorelin does raise growth hormone and IGF-1, and small physiology studies show GHRH increases slow-wave sleep, but the fat loss and muscle data come from trials of tesamorelin in HIV patients, and no trial has tested sermorelin for anti-aging in healthy adults.
- BFDA approvedSetmelanotideMC4R agonist
In rare genetic and brain-injury forms of obesity, setmelanotide produces large sustained weight loss in trials ranging from 10 to 142 patients, with skin darkening and nausea as the trade-offs; it has not been tested as a treatment for ordinary obesity.
- BFDA approvedSincalideCholecystokinin analog
Sincalide reliably contracts the gallbladder and stimulates pancreatic enzyme output, and a 60-person multicenter study standardized how to infuse it for imaging; that is solid for a diagnostic agent but is not outcome-trial evidence.
- AFDA approvedSomapacitanLong-acting GH analog
Randomized trials show weekly somapacitan reduces body fat in adults with growth hormone deficiency as well as daily growth hormone does and produces equivalent growth in children, which supports an A for its approved uses.
- AFDA approvedSomatropin (rhGH)Growth hormone
Somatropin reliably restores growth in children who lack growth hormone and improves body composition in deficient adults, which is what it is approved for; the labels do not support use in healthy adults, and the market is shifting toward weekly long-acting versions as older daily brands exit.
- BIn trialsSurvodutideGLP-1 / glucagon dual agonist
Randomized trials show large placebo-adjusted weight loss and liver-fat reduction, but the drug is unapproved and long-term outcome data do not yet exist, which is why it grades B.
- CNot approvedTB-500Synthetic Tβ4 fragment
Nothing published tests TB-500 for injury in humans or animals; the evidence for its parent protein comes from small trials in wounds and the eye, so the grade is C.
- AFDA approvedTeduglutideGLP-2 analog
Randomized and long-term extension data show meaningful reductions in parenteral support volume, with a minority of patients weaning off entirely, which supports the A grade for its approved indication.
- AFDA approvedTeriparatidePTH analog
A large randomized trial showed fewer spine and non-spine fractures in high-risk postmenopausal women, and two decades of use have not shown the bone cancer signal seen in rats, which is why it grades A.
- AFDA approvedTerlipressinVasopressin analog
A 300-patient randomized trial showed more reversals of hepatorenal syndrome than placebo, at the cost of more respiratory failure and no survival gain, which supports an A grade for the narrow approved use.
- BFDA approvedTesamorelinGHRH analog
In people with HIV it reliably cuts visceral fat by about 15 percent over six months, but the fat returns when the drug stops and the evidence in people without HIV is a single small trial, which is the logic of the B grade.
- BNot approvedTesamorelin (compounded)GHRH analog
It reliably cuts visceral fat by about 15% in HIV lipodystrophy, one 60-person trial suggests a similar selective effect in obese adults without HIV, and the fat returns within months of stopping, so the off-label use rests on a single small trial.
- BNot approvedThymosin alpha-1Immunomodulatory peptide
Randomized trials support a modest, delayed antiviral effect in chronic hepatitis B, a large trial found no benefit in sepsis, and there are no trials of the immune-boosting uses marketed in the US, which is why it grades B.
- BNot approvedThymosin beta-4Actin-regulating peptide
Small randomized trials show safety and signals of benefit in eye and heart disease, but the injected use for sports injuries has never been tested in people, which is why it grades B for the studied indications and no better.
- CNot approvedThymulinThymic immune peptide
Thymulin is a real thymic hormone whose biology is well described in animals, but no human trial has tested giving it as a drug, which puts it at C.
- AFDA approvedTirzepatideDual GIP + GLP-1 receptor agonist
Multiple large randomized trials show weight loss of 15 to 21 percent, better glucose control than other diabetes drugs, and improvement in sleep apnea, with weight regain after stopping, which is a clean A.
- DCosmeticTripeptide-10 citrullineSignal peptide
A single manufacturer study shows the peptide alters collagen fiber assembly in a test tube and reports a small volunteer study, which does not establish a clinical effect, hence D.
- AFDA approvedTriptorelinGnRH agonist
Randomized trials show it drives testosterone to castrate levels as reliably as leuprolide, which supports an A for its approved indications.
- AFDA approvedTrofinetideIGF-1-derived tripeptide analog
A single well-run phase 3 trial showed statistically significant improvement on caregiver and clinician rating scales, with diarrhea in four out of five patients, which earns an A for the approved indication.
- CFDA approvedTrofinetide (predecessor programs)IGF-1-derived peptide
The non-Rett programs produced small early trials and were dropped, so they grade C; only the Rett indication reached phase 3.
- AFDA approvedVancomycinGlycopeptide antibiotic
Randomized trials and more than 65 years of use support both the intravenous and oral indications, with kidney toxicity and rising resistance as the known costs, hence A.
- AFDA approvedVasopressinV1/V2 receptor agonist
A 778-patient randomized trial showed vasopressin raises blood pressure as well as norepinephrine without improving survival, which supports A for its approved hemodynamic indication.
- AFDA approvedVosoritideCNP analog
One randomized trial showed about 1.6 centimeters per year of extra growth, with final adult height and effects on complications still unproven, which is why it holds an A under accelerated approval.
- AFDA approvedZiconotideN-type Ca-channel blocker (conotoxin)
Randomized trials show substantial pain relief over placebo in refractory patients, bought at the price of frequent neurological and psychiatric side effects, which keeps it an A for its narrow approved use.
- AFDA approvedZilucoplanComplement C5 inhibitor peptide
A 174-patient randomized trial showed clinically meaningful improvement in daily-living symptoms over placebo at 12 weeks, with the class risk of meningococcal infection, which supports an A.
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