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Explore peptides and ingredients
Educational guides and explanations: learn how each peptide or ingredient works and what the evidence says. This section is our Library: every peptide in common use, graded on the strength of the evidence behind it — A for multiple human trials, D for animal and laboratory work only. How we grade →
What this is not: an evidence grade describes the research on an ingredient. It is not a safety or quality verdict on any specific product. To see which products we checked, go to Check a product. Peptides also sit in different legal categories depending on what they are and how they are sold: see Are peptides legal?
What category is this product? (US rules)
Medicines, cosmetic ingredients, dietary products and unauthorized injectables follow different rules. These four guides explain the difference: are peptide skincare products FDA-approved?, can a serum claim to boost collagen?, is a peptide supplement approved by the FDA? and peptide or biologic: where FDA draws the line.
Common questions, answered in plain English
Start here if you have a question rather than an ingredient name: What is a peptide?, Are peptides safe?, Peptide side effects, How long do peptides take to work?, Peptides for skin vs peptides for muscle, Peptides vs retinol vs vitamin C, Peptides for the under-eye area, How to read a certificate of analysis and Semaglutide vs tirzepatide.
Comparing medicines, and telling approved products from unapproved ones
These guides compare specific medicines using their labels and published trials, and explain regulatory status without naming sellers: Liraglutide vs semaglutide, Generic vs compounded liraglutide, Triptorelin vs leuprolide, CagriSema FDA application and Kisspeptin vs gonadorelin vs hCG.
Guides
- How copper peptides appear on cosmetic ingredient labels
- How to read a skincare ingredient label
- Is a peptide skincare product a cosmetic or a drug?
- Are peptides worth it?
- BPC-157 vs TB-500
- Can you use peptides with retinol?
- Canada's peptide compounding loophole
- CJC-1295 vs Ipamorelin
- Collagen vs peptides: the difference
- Copper peptide side effects
- Do collagen peptides actually work?
- Do peptides work for hair growth?
- FDA warning letters to peptide vendors
- Health Canada peptide vendor actions
- How do peptides work in the body?
- How much peptide should a serum have?
- How the EU classifies a peptide
- How the MHRA classifies a peptide
- How we review: no pay-to-rank
- HPLC vs mass spectrometry explained
- Matrixyl vs Argireline
- Mounjaro, Wegovy on Australia's PBS?
- NHP or drug? How Health Canada decides
- Ozempic insurance coverage in Canada
- Peptide glossary
- Peptide skincare for beginners
- Peptide vendor red flags
- Peptides vs proteins vs amino acids
- Signal vs carrier vs neurotransmitter
- TGA's 2024 compounding ban, enforcement
- Types of peptides: a map of the Library
- UK peptide and SARMs vendor actions
- Wegovy, Mounjaro reimbursement: Belgium
- Wegovy, Mounjaro reimbursement: France
- What are peptides used for?
- What does "Research Use Only" mean?
- What does a peptide serum actually do?
- What order for peptides in a routine?
A
Collagen support with human trial evidence behind it.
A
Around 20% reduction in wrinkle depth at 3% over eight weeks.
B
Genuinely mixed evidence — one independent 2023 evaluation found no measurable effect at all.
B
Lipidated GHK fragment with better penetration than the parent peptide.
B
The one ingestible peptide category with an established lawful status.
A
Approved medicine. Proposed for exclusion from the 503B bulks list.
A
Approved medicine. Proposed for exclusion from the 503B bulks list.
B
Approved in branded form for a specific indication; widely sold grey-market above label dose.
B
Real human trials exist — for reproductive research, not the libido products it's sold as.
B
Genuinely approved once, for a pediatric use — withdrawn in 2008 for commercial reasons, not safety.
C
Approved elsewhere for narrow indications; not in the US. Its largest sepsis trial found no benefit.
C
Real human PD data; FDA's advisory committee voted against it for compounding eligibility.
C
Its one real clinical trial, for bowel recovery, found no benefit over placebo.
D
Heavily marketed on almost entirely rodent data. Removed from Category 2 in April 2026 — not the same as permitted.
D
The trial evidence cited for it was run on a different, larger molecule. Not a lawful supplement ingredient.
D
A real, dedicated 536-person trial found it doesn't work. Development was halted in 2007.
D
Longevity claims trace largely to one research group's 2003 cell-culture study.
D
Interesting biology; a very wide gap between it and the marketing.
D
Its "cardioprotective" reputation comes from rat hearts, not a human trial.
D
GHRP-2 is a real, narrow diagnostic approval in Japan — not the treatment it's sold as.
D
Never approved. Real published case reports link it to melanoma and rhabdomyolysis.
A
Approved twice, as Victoza and Saxenda. The GLP-1 that came before Ozempic and Wegovy.
B
Not approved anywhere yet, but real Phase 2 data — and already the target of real FDA warning letters online.
B
Not yet approved alone or combined — but real Phase 3 data exists and Novo Nordisk reports an FDA application is filed.
B
Really approved for fertility use. FDA's own label says it doesn't work for weight loss.
B
Genuinely approved once, for diagnostics and fertility — both now listed as discontinued by FDA.
C
A registered Russian stroke drug with real, decades-old trial data never replicated in the West.
D
FDA's advisory committee voted it down in 2026 — the only one of seven peptides reviewed to be rejected.
D
Zero published human trials found, despite a 2026 FDA advisory-committee recommendation for compounding.
C
The real protein behind "TB-500." One trial trended positive; a larger 2026 trial missed its endpoint.
C
The only human trial data is from a tiny gene-therapy study — not the injectable peptide sold online.
B
A real obstetric drug. Its largest controlled trial for a social/bonding outcome found no benefit.
B
A real diagnostic drug whose only US product stopped being made in 2002. No trial backs its wellness use.
A
A real approved GHRH analog — the one member of this drug class that actually cleared FDA approval.
B
Genuinely approved for real deficiency states. Prohibited in all sport; no trial evidence for the muscle-building use it's sold for off-label.
A
The same somatropin already used daily, released from an inert carrier over a week instead — approved for children in 2021, adults in 2025.
A
A different once-weekly engineering trick than lonapegsomatropin — reversible albumin binding, now covering adults plus four pediatric indications.
B
The real, FDA-approved twin of Melanotan II — approved for a rare disease, not the tanning use it's sold for online.
C
Real Cochrane-reviewed trials in stroke and dementia; the current verdict is still "probably little or no benefit."
C
Two real Russian comparator trials against benzodiazepines, never independently replicated in the West.
C
A real antioxidant tripeptide with thin efficacy evidence for the injectable route and a real, recent contamination track record.
C
Argireline's bigger sibling. The "63%" figure traces to the manufacturer's own testing, not an independent trial.
D
Zero published human clinical trials, per a dedicated 2026 review.
D
Real muscle-repair biology in animals; no human trial evidence that it works as sold.
A
The melanocortin-family drug with a real, current, genetic-testing-gated FDA approval for obesity — not a tanning or libido product.
A
A real, decades-approved drug that suppresses GH — the mirror image of this site's GH-secretagogue cluster.
B
Cagrilintide's approved ancestor — real trial evidence, two decades on market, discontinued in 2025.
B
The original approved GLP-1 drug, a decade before semaglutide — discontinued by its maker in October 2024.
C
A real drug since 1952 — thin modern trial evidence for its priciest uses, and a real $260M+ federal enforcement record.
A
Same GnRH mechanism and era as gonadorelin — but still in wide, current mainstream use rather than discontinued.
A
A genuinely mainstream, decades-approved peptide drug — and a real hyponatremia risk worth knowing across every use.
D
Real biology, zero completed human trials — MOTS-c's sibling peptide, with the same evidence gap.
B
A real, narrow FDA approval in 2025 for Barth syndrome, alongside a real completed Phase 3 failure elsewhere.
A
A real, current, different-family FDA approval for achondroplasia — with a genuine, unresolved community debate about the goal itself.
A
Proved bone-building therapy works. Its boxed warning was removed by FDA in 2020 after 18 years of human surveillance found no cancer signal.
A
Teriparatide's approved cousin — an 86% vertebral-fracture reduction in its own placebo-controlled trial.
B
A real, older bone drug whose role shrank after a 2013 FDA review found a real cancer signal in pooled trial data.
B
The first approved peptide drug to block HIV by fusion inhibition — real efficacy, but a tolerability burden that pushed it to last resort.
B
A real rescue drug for hereditary angioedema attacks — though its very first pivotal trial missed against placebo.
B
The real hormone that raises blood sugar. Its newest, easiest-to-use formulations rest on a thinner public trial record than most drugs here.
C
A real drug whose risk-benefit picture genuinely shifted after approval — a large 2011 trial found no confirmed harm, but no real benefit either.
D
Never tested in humans by the company that held its rights. Its closest tested relative failed two separate trials.
B
A real, investigational dual agonist with published Phase 2 data and positive 2026 Phase 3 topline results, not yet approved anywhere.
A
A real, approved GLP-2 analog for short bowel syndrome — the therapeutic opposite of the GLP-1 drugs covered elsewhere here.
A
Octreotide's approved sibling — same receptor class, monthly depot dosing, and a strong 2014 NEJM trial behind it.
B
Approved for Cushing's disease and acromegaly separately — but its own pivotal trial normalized cortisol in barely a quarter of patients.
A
The antagonist mirror image of leuprolide — no testosterone flare, non-inferior in its own pivotal trial.
A
Leuprolide's close cousin, approved for both prostate cancer and, separately, precocious puberty.
A
Delivered as an implant, not an injection — and approved for prostate cancer, breast cancer, and endometriosis.
A
The IVF antagonist pair — a real 2025 study found cetrorelix edges out ganirelix on OHSS risk despite similar live-birth rates.
B
The exact native peptide itself, approved for septic shock on a blood-pressure endpoint — not a proven mortality benefit.
B
A synthetic amino-acid mixture for MS whose own FDA label admits the mechanism still isn't fully understood.
A
A "peptibody" for chronic ITP carrying a boxed warning about leukemia progression — in a population it isn't even approved to treat.
D
Approved in 2012, recalled in 2013 after fatal anaphylaxis reports, formally withdrawn by the FDA in 2019.
A
A major, still-marketed GLP-1 drug for diabetes — plus a real, separate FDA approval for cutting cardiovascular events.
B
Discontinued in 2017 for business reasons — then vindicated by a positive cardiovascular trial published over a year later.
B
A genuinely neutral cardiovascular trial result, discontinued in the US in 2023 for commercial reasons.
A
Blocks growth hormone at the receptor rather than suppressing its release — a genuinely different acromegaly mechanism.
B
Real leptin-replacement evidence for an ultra-rare disease, approved without a placebo-controlled trial for ethical reasons.
A
A real diagnostic-only ACTH fragment used to test adrenal function — not a treatment for anything.
A
A real diagnostic peptide for pancreatic/gastrinoma testing — and a cautionary tale after years of unproven use as an autism treatment.
A
A real diagnostic CCK fragment used to provoke gallbladder contraction during HIDA scans.
B
A genuinely recent (2022) approval for hepatorenal syndrome — real kidney benefit, boxed warning for respiratory failure.
A
Approved worldwide to prevent postpartum hemorrhage — genuinely still not FDA-approved in the US.
A
Treats the same condition as icatibant from the opposite direction — but its own anaphylaxis risk means a clinician must give it.
A
A hospital-only anticoagulant engineered from leech-saliva peptide hirudin, used during coronary angioplasty.
A
A cyclic peptide antiplatelet drug derived from rattlesnake venom — its brand is gone, but the generic remains widely available.
A
A membrane-disrupting antibiotic inactivated by lung surfactant — it cannot treat pneumonia no matter how susceptible the bacteria are.
A
Approved in 1958, before modern efficacy trials existed — still the frontline MRSA drug despite real emerging resistance.
B
Discovered from an infected childhood wound in 1945 — now topical-only after systemic use proved significantly toxic to the kidneys.
B
A revived last-resort antibiotic — and the 2015-2016 discovery of transferable resistance (mcr-1) was a real global-health alarm.
B
Colistin's close cousin, given as the active drug directly rather than a prodrug — also the polymyxin in Neosporin and Polytrim.
A
A bacterial-toxin-derived peptide for IBS-C/constipation, carrying a precise pediatric boxed warning traced to a specific preclinical finding.
A
Linaclotide's cousin, modeled on the body's own uroguanylin rather than a bacterial toxin — same indications, same pediatric warning.
B
Bypasses the GH axis entirely for a rare pediatric growth-failure disease — approved without a randomized control group.
A
The same GnRH-agonist implant sold under two brands for two different patients — one of which was discontinued in 2021.
A
The first hypoparathyroidism drug, withdrawn over a cartridge defect — succeeded by a re-engineered PEGylated replacement.
B
The real, unmodified hormone itself, used for vasodilatory shock — its own major trial produced a genuinely neutral result.
D
A large, clean, well-designed heart-failure trial that missed both co-primary endpoints — never approved anywhere.
C
Approved in Japan since 1995 without a modern-style outcomes trial — real-world data has since raised a mortality concern.
A
A real diagnostic hormone for Cushing's syndrome workups, discontinued in 2020 — its absence measurably hurt diagnostic accuracy.
A
Recombinant FSH for IVF and ovulation induction, approved 1997 — manufactured rather than urine-purified, same biological effect.
B
Urinary-derived FSH/LH-like fertility drug with a remarkable origin story — purified from postmenopausal urine collected across Italian convents.
B
Recombinant LH for profound LH-deficient IVF patients — approved 2004, formally withdrawn 2016 after the required confirmatory trial never happened.
A
Recombinant hCG trigger shot for IVF, approved 2000 — mechanistically identical to urinary hCG, manufacturing consistency is the real difference.
A
Recombinant TSH for thyroid cancer follow-up, letting patients stay on thyroid medication instead of becoming deliberately hypothyroid for testing.
B
Semi-synthetic vancomycin descendant with a dual mechanism and a three-part boxed warning, including teratogenicity shown in animal studies.
A
Long-half-life lipoglycopeptide antibiotic — an entire treatment course delivered in just one or two IV doses instead of days of infusions.
A
Single-dose lipoglycopeptide antibiotic with activity against vancomycin-resistant enterococci and a real lab-interference quirk on clotting tests.
B
Recombinant erythropoietin approved 1989 — a landmark early biotech drug, now carrying a significant 2007 boxed warning after normalization trials backfired.
B
Longer-acting engineered erythropoietin analog — subject to the same 2007 boxed warning, with its own trial (TREAT) finding a doubled stroke risk.
A
Recombinant G-CSF that reduces infection risk during chemotherapy — its 2015 biosimilar, Zarxio, was the first biosimilar ever approved in the US.
A
PEGylated filgrastim engineered so its own clearance is regulated by neutrophil count — one dose per chemo cycle instead of daily injections.
A
A non-opioid painkiller derived from cone-snail venom, delivered only by implanted spinal pump for severe chronic pain.
A
A peripherally restricted kappa-opioid peptide for hemodialysis itch, engineered to avoid crossing into the brain.
A
An oral ghrelin-receptor peptide used as a one-time diagnostic test for adult growth hormone deficiency, not a treatment.
B
A mainstream labor-delaying drug across the EU and Canada since 2000 — never FDA-approved, after a US trial's fetal-death signal.
A
The first FDA-approved treatment for Rett syndrome, a synthetic analog of a natural IGF-1 breakdown fragment.
A
Nasal-spray GnRH agonist for endometriosis and central precocious puberty — same class as leuprolide, delivered without an injection.
A
Recombinant hirudin analog for DVT prevention after hip replacement — real trials found it beat both heparin and enoxaparin, no longer marketed in the US.
B
The first approved HIT-specific anticoagulant, discontinued in 2012 for commercial reasons — not the safety failure some assume.
A
Recombinant GM-CSF approved for bone marrow recovery in 1991, then for acute radiation syndrome in 2018 based entirely on animal studies.
B
Same mechanism as leuprolide, used in one of the original 1982 trials for the drug class — never FDA-approved, apparently for market-timing reasons.
B
Vancomycin's Cochrane-reviewed cousin — equally effective and less nephrotoxic, reviewed by an FDA panel in the 1990s, still never approved in the US.
A
Three approved antifungals blocking a fungal-only cell-wall target — and a real case of the FDA and EMA reading the same rat-tumor data differently.
A
A peptide that lowers parathyroid hormone by the opposite mechanism from this site's PTH-analog drugs — three Phase 3 trials, over 1,700 patients.
A
Octreotide's radioactive cousin — a real cancer treatment, and the first peptide-receptor radionuclide therapy ever approved.
A
A once-daily self-injected peptide doing an antibody drug's job — real Phase 3 data, and the same boxed warning every C5 inhibitor carries.
A
The first genetically-engineered drug ever approved (1982) — and the peptide behind the biggest US drug-pricing story of the last decade.
B
The first synthetic peptide-containing lung surfactant approved — then withdrawn commercially in 2015, for business reasons, not safety.
A
The third once-weekly growth hormone on this site — approved in Canada well before the FDA, and still pediatric-only after its own adult trial missed its primary endpoint.
A
Clears out myasthenia gravis's disease-driving antibodies wholesale — approved 2021, then expanded into CIDP (2024) and every gMG antibody subtype (2026).
A
The first once-weekly basal insulin approved anywhere — cleared in Switzerland, Canada and the EU in 2024, then rejected and finally approved by the FDA almost two years later, for type 2 diabetes only.
A
Solves a real stem-cell-collection bottleneck for multiple myeloma transplant patients — 92.5% hit the collection target on it versus 26.2% on placebo. FDA-approved 2023.
A
A real cardiovascular signal triggered a 2013 FDA rejection and a dedicated 7,637-patient outcomes trial — approved 2015 after the trial found no added risk and 40% less severe hypoglycemia.
B
A real approved medicine in China (2025) on strong Phase 3 data — but not approved anywhere in the West, and already named in this site's own FDA warning letters to unauthorized US sellers.
D
Real Phase 3 efficacy data across 6,000+ patients — halted in 2010 by a hypersensitivity/anaphylaxis signal before ever reaching market.
C
A 2011 hip-fracture trial was stopped early for heart failure — yet the same molecule is now in an actively-recruiting Phase 3 pediatric trial under a different name.
A
One active ingredient, three real FDA approvals in three unrelated diseases (2021, 2023, 2025) — plus a genuine post-marketing retinal-safety signal in the eye-injection formulation.
D
A striking mortality signal in its first Phase 3 trial wasn't enough for FDA approval — the larger confirmatory trial regulators required came back negative, ending development.
A
An FDA-approved hereditary angioedema drug purified from transgenic rabbits' milk — approved for treating attacks, rejected in 2018 for preventing them.
A
The two original human-plasma HAE replacement drugs, approved a year apart for opposite jobs — Cinryze (2008) to prevent attacks, Berinert (2009) to treat one already underway.
A
A real, 1989-approved protein drug with a dozen-plus indications — and two separate CDC-documented 2024-2025 outbreaks tied to counterfeit product and online self-injection, not the approved drug itself.
A
A 1994-approved Gaucher disease enzyme drug whose only factory got shut down by a 2009 virus contamination — triggering a years-long shortage, a $175 million FDA penalty, and a permanent shift of patients to newer rivals.
A
VPRIV & Elelyso · Gaucher enzyme replacements
Grade A evidence
Two competing Gaucher disease drugs fast-tracked to market by the Cerezyme shortage — one grown in human cells, the other the first plant-cell-expressed drug the FDA had ever approved.
A
An enzyme humans lost through evolution, restored by infusion for severe gout — until antibodies against its own PEG coating stop it working, a problem a 2022-approved methotrexate combination directly addresses.
A
A 2003-approved Fabry disease enzyme drug hit by the same 2009 Genzyme plant contamination as Cerezyme — but rationed to about 30% dose for nearly three years, and not converted from accelerated to full FDA approval until 2021.
A
A third Fabry disease enzyme, grown in plant cells and PEGylated for a longer half-life — a 2021 rejection over a COVID-blocked factory inspection delayed its 2023 approval by two years.
A
Turned uniformly fatal infantile Pompe disease into a treatable one — then got approved a second time under a different brand name because a bigger factory counted as a new product, with a restricted-use program not lifted until 2014.
A
A second-generation Pompe enzyme carrying substantially more of the uptake tag muscle cells use to absorb it — approved for adults in 2021, with an infant indication still pending FDA filing in 2026.
A
The first MPS I treatment, approved 2003 — a unanimous FDA advisory vote still wasn't enough to skip a further three-month delay, and it reached market through an unusual 50/50 joint venture between two separate biotechs.
A
A real 2006 Hunter syndrome treatment that can't cross the blood-brain barrier — a decade-long, injected-into-the-spine version built to fix that failed its pivotal trial in 2017 and was discontinued in 2022.
A
A fourth Pompe disease enzyme whose own pivotal trial missed its primary endpoint for statistical significance — approved anyway on secondary evidence, then delayed a year by a COVID-blocked factory inspection, not the data.
A
The first insulin analog ever approved (1996) — and the single insulin product most tied to the US pricing crisis, from a $21 launch price to a 2017 rationing death that became a state law.
A
A second, independently engineered rapid-acting analog approved in 2000 — now the first insulin with real 2025 biosimilar competition, including the first interchangeable rapid-acting insulin biosimilar.
A
The first long-acting basal insulin analog (2000) — its patent litigation against Eli Lilly and Merck shaped how insulin biosimilars reached the US market at all.
A
A 1993-approved cystic fibrosis enzyme that succeeded where a 1958 bovine version failed on allergic grounds — and still has no FDA-approved biosimilar over a decade after its US patents expired.
A
Clears a cancer-emergency uric acid surge within hours — but carries three boxed warnings, and real-world practice has shifted toward off-label doses far below the original FDA label.
A
The first MPS IVA treatment, approved 2014 — its own pivotal trial found the weekly dose worked and the every-other-week dose didn't, and a $380,000 list price took a five-year UK managed-access deal to resolve.
A
The first MPS VI treatment, approved 2005 — a real placebo-controlled trial win, later extended down to infants as young as three months in a dedicated follow-on study.
A
The first MPS VII treatment, approved 2017, for a disease with perhaps 200 known patients worldwide — developed by Ultragenyx, not the BioMarin behind every other MPS drug on this site.
A
A first-in-class PAH drug approved 2024 — its pivotal trial cut death or clinical worsening by 84%, and a second 2025 trial expanded the label to the highest-risk patients.
A
One of the first TNF-blocker biologics, approved 1998 — FDA-approved US biosimilars have existed since 2016 without ever reaching a patient, blocked by patents until 2029.
A
One fusion protein sold as three separate approved drugs since 2011 — now the subject of a live, multi-front biosimilar patent war with one at-risk launch already underway.
A
The original recombinant clot-buster, approved since 1987 — its own FDA stroke label still stops at 3 hours even though guidelines have endorsed 4.5 hours for over a decade.
B
Alteplase re-engineered for two-bolus dosing — never beat alteplase's own survival numbers for heart attack, but a 2024 Chinese trial found it wins for a disease it isn't approved to treat: stroke.
A
Approved for heart attack in 2000 on a 17,000-patient trial — then became the first new FDA-approved stroke medicine in nearly 30 years, in March 2025.
B
The original thrombolytic, approved 1977 — no longer sold in the US or Canada, displaced once an accelerated tPA regimen beat it on survival in 1993.
B
Approved 1978, pulled in 1999 over unscreened contaminated kidney cells, reapproved 2002 — off the US market again, with a funded 2028 comeback plan underway.
B
Approved 1989, roughly halved 30-day mortality against placebo — displaced within a decade once bolus-dosed tPA drugs matched its convenience without the antigenicity.
A
The original CXCR4 antagonist, discovered as an anti-HIV drug before an unrelated side effect redirected it into cancer supportive care — approved 2008, now generic since 2023.
A
The first approved drug for cold agglutinin disease, a rare autoimmune anemia — a 2020 rejection was over a factory inspection, not the drug's own data, and a 2024 study found it isn't cost-effective at its current price.
A
The first LAL deficiency treatment, approved 2015 for both the rapidly fatal infant form and the later-onset form — purified from the eggs of genetically engineered chickens, only the second FDA-approved drug ever made this way.
A
The only approved ASMD (Niemann-Pick B) treatment — first cleared in Japan in 2022 under a pioneer fast-track designation, months before the FDA; the label explicitly excludes the disease's neurological form, which the enzyme can't reach.
A
A PKU drug that substitutes an entirely different bacterial enzyme rather than restoring the missing human one — approved 2018 with a boxed warning and mandatory REMS for anaphylaxis, extended to adolescents only in February 2026.
A
The first engineered insulin to use reversible albumin binding, and the only basal insulin ever granted FDA pregnancy category B — discontinued in the US entirely through 2024 despite that record.
B
Sanofi walked away from launching it in 2019, before its own pivotal trial reported a real 27% cardiovascular-risk reduction. Now being repositioned for a South Korean obesity filing, with no US or EU application pending.
A
A chemically restructured glucagon, not a reformulation of the native hormone — approved 2021, and now also being tested as the glucagon half of a dual-hormone artificial pancreas.
B
Missed its own primary endpoint in a Phase 2b cirrhosis trial, then reported a real 96-week cirrhosis-reversal signal — real enough that Novo Nordisk paid up to $5.2 billion for it in December 2025.
B
Cleanly met both primary endpoints in a Phase 2b trial and holds FDA Breakthrough Therapy status since 2023 — now a Roche asset after a deal worth up to $3.5 billion closed October 2025.
B
GSK's $2 billion once-monthly FGF21 bet just won FDA Breakthrough and EMA PRIME status in April 2026 — on the smallest completed trial of this site's three FGF21 analogs.
A
The first FDA-approved GLP-1 drug that's a small molecule, not a peptide — approved 1 April 2026, MHRA-approved in the UK by August 2026, still pending in the EU, Australia and Canada.
C
Pfizer's competing oral GLP-1 pill — real Phase 2 weight-loss data, discontinued in April 2025 after a liver-injury signal, following a related Pfizer candidate stopped the same way in 2023.
A
This site's second radioligand cancer therapy after Lutathera — approved 2022 on a real survival benefit, then expanded twice more (2025, 2026) after a 2022-2023 supply crisis got fixed.
A
A fourth engineered G-CSF joining this site's filgrastim/pegfilgrastim cluster — approved 2023 on a placebo-controlled trial and a head-to-head noninferiority win against pegfilgrastim.
A
Two unrelated companies' answers to blocking interleukin-1 — approved seven years apart, then both approved for the identical ultra-rare disease one week apart in December 2020.
A
Takhzyro & Andembry · plasma-kallikrein and Factor XIIa antibodies
Grade A evidence
Two more ways to block hereditary angioedema's bradykinin cascade — lanadelumab (2018) and garadacimab, approved in five other countries before the FDA cleared it in June 2025.
A
A fourth echinocandin engineered for once-weekly dosing — approved 2023 on a single pivotal trial and a narrower label than its class predecessors, after the FDA flagged a neurotoxicity signal.
A
A genuinely new drug class — a synthetic hepcidin mimetic that restricts iron for erythropoiesis, approved 2026 for polycythemia vera on a real placebo-controlled Phase 3 trial.
B
Lilly's once-weekly basal insulin, built as an antibody Fc fusion instead of an albumin binder — FDA-approved 23 September 2026 for adults with type 2 diabetes only.
A
The original antibody drugs this site's own pegcetacoplan and zilucoplan pages reference — plus an SEC bribery settlement, a $125M investor settlement, and 2024's first biosimilars.
A
The one oral drug in this site's hereditary angioedema cluster — a once-daily pill approved 2020 on a real placebo-controlled trial, versus five injectable alternatives.
A
Altuviiio & Hemlibra · factor VIII replacement and bispecific antibody
Grade A evidence
Two opposite fixes for hemophilia A's missing clotting factor — an engineered factor VIII built to break a real half-life ceiling (2023), and a bispecific antibody that skips factor VIII entirely, working even with inhibitors (2017).
A
The first bispecific antibody built for the eye, approved 2022 — matched this site's own aflibercept on vision outcomes with fewer injections, plus a real post-marketing eye-inflammation signal.
A
The third rapid-acting insulin analog, approved 2004 — the only one formulated without zinc, with no pricing scandal attached, just a real 70% US list-price cut in 2024.
A
A third anti-C5 antibody for PNH, approved 2024 — engineered for once-monthly home self-injection instead of clinic infusion, matching eculizumab in two head-to-head Phase 3 trials.
A
The first treatment for hypophosphatasia, approved 2015, with a real survival benefit against historical controls — and a roughly $285,000-a-year price that a UK regulator initially refused to cover.
A
A genuinely new hemophilia drug class from two rival companies — both approved late 2024, both since expanded to cover more patients, and a real 2020 clinical hold that paused concizumab's trials after thrombotic events.
A
The only approved treatment for alpha-mannosidosis — a clean 2018 biomarker win in the EU, a motor-function endpoint that fell short of significance, and a nearly five-year wait before the FDA approved it too.
A
A second Fabry disease enzyme, EU-approved in 2001 — but the one drug in this site's Fabry cluster never approved in the US, after Shire withdrew its FDA application in 2012 over a demand for more controlled trials.
A
A fourth anti-C5 antibody, approved 2023 for CHAPLE disease — an ultra-rare complement disorder so uncommon the FDA accepted a 10-patient, placebo-free trial as its entire evidence base.
A
A second FcRn blocker for myasthenia gravis, approved 2023 — the first FDA-approved gMG drug covering both AChR- and MuSK-antibody-positive patients from day one.
C
The first GnRH antagonist ever approved, 2003 — restricted to a mandatory allergic-reaction-monitoring program from day one, and discontinued from US sale by 2005.
A
One injection replaces the first seven days of daily FSH shots in IVF, EU-approved since 2010 — but never approved by the FDA after a 2014 rejection.
A
This site's HAE cluster's missing on-demand oral drug — approved July 2025 as the first pill for treating an attack already underway, not just preventing one.
A
This site's bone cluster's missing modern standard — a real 68% vertebral-fracture reduction in its 2009 pivotal trial, and a January 2024 boxed warning after dialysis-registry data found severe hypocalcemia in 41% of treated patients.
A
The one drug in this site's bone cluster that builds and preserves bone at once — approved in Japan first, then delayed over a year in the US after a real cardiovascular signal forced a boxed warning.
A
A third FcRn blocker for myasthenia gravis, approved 2025 for the broadest antibody-positive population yet — then, in August 2026, the first drug ever approved for a second, unrelated disease: warm autoimmune hemolytic anemia.
B
A real, investigational dual agonist in three separate programs — obesity, MASH, and alcohol use disorder — with published Phase 2 data in the first two and a positive July 2026 topline readout in the third.
B
A real, investigational once-monthly obesity drug built on a genuinely new modality — up to 20% weight loss in its published Phase 2 trial, and a real tolerability problem that forced Amgen to redesign its Phase 3 dosing.
B
A real, investigational single-molecule GLP-1/amylin dual agonist in both injectable and oral form, with published Phase 1 data — but earlier in development than this site's other 2026 GLP-1-family additions.
211 of 211 ingredients · 271 pages published, the rest scheduled