Research & literature
This section catalogues the primary literature, safety advisories, and regulatory updates underpinning peptide articles on PeptideSciences101. Each peptide page also lists its own references; this index aggregates across all peptides. Entries record sourced facts only — no dosage guidance.
42 entries
2026
Semaglutide, Tirzepatide · studies · 2026-08-31
›Summary
A peer-reviewed retrospective electronic-health-record study compared patients with sustained prescriptions at the lowest marketed initiation doses of semaglutide (0.25 mg) and tirzepatide (2.5 mg). Using a federated EHR system covering 29 million patients, the authors identified 814 semaglutide-treated and 1,016 tirzepatide-treated patients meeting a stringent sustained low-dose prescription criterion. In matched analyses, mean 12-month weight change was -2.2% with semaglutide and -5.5% with tirzepatide. The paper also reported several higher observed adverse-event rates in the tirzepatide cohort, including constipation and acute kidney injury. Critically, the authors state that this prescribing pattern may overlap with, but does not establish, intentional microdosing. This is observational, hypothesis-generating evidence rather than a randomized test of a microdosing protocol; it does not establish causality, long-term safety, or an optimized low-dose regimen.
Tirzepatide · regulatory · 2026-08-28
›Summary
FDA approved Mounjaro (tirzepatide) to reduce the risk of major adverse cardiovascular events (MACE) — cardiovascular death, non-fatal heart attack, or non-fatal stroke — in adults with type 2 diabetes who are at high risk for these events, based on the SURPASS-CVOT trial (13,299 adults with type 2 diabetes and established atherosclerotic cardiovascular disease across 640 sites in 30 countries). SURPASS-CVOT compared Mounjaro against Trulicity (dulaglutide), an active comparator with its own established cardiovascular benefit, and was designed as a non-inferiority trial: the hazard ratio for time to first MACE was 0.92 (95.3% CI 0.83-1.01), described by the sponsor as "non-inferiority to dulaglutide" with "an 8% lower rate" of the composite endpoint. The sponsor's release explicitly states superiority to dulaglutide was not established — the confidence interval crosses 1.00. The indication is specific to adults with type 2 diabetes at high cardiovascular risk, not a general cardiovascular-protection claim.
Tirzepatide, Semaglutide, Retatrutide, SS-31 (Elamipretide), PT-141, Tesamorelin, Ipamorelin · regulatory · 2026-08-24
›Summary
FDA issued a warning letter to Royal Peptides LLC after reviewing its website in July 2026. FDA identified products marketed as tirzepatide, semaglutide, retatrutide, SS-31 (elamipretide), PT-141, tesamorelin and a tesamorelin/ipamorelin blend (BIMORELIN) as unapproved new drugs based on evidence of intended drug use in the company's labeling and website claims. In a footnote, FDA specifically stated that despite labeling the products “for research use only” and “not for human or animal consumption,” evidence from the website established that the products were intended as drugs for human use. FDA further stated that the company marketed bacteriostatic water alongside a peptide guide and peptide calculator, resources that collectively provided the means to prepare an injectable drug for human administration. The warning letter concerns the specific products and marketing FDA reviewed; it is not a finding that legitimate scientific peptide research is unlawful. FDA warning letters describe the agency's position at the time issued and may be followed by subsequent interactions with the recipient.
Semaglutide, Tirzepatide, Liraglutide, Teriparatide, Calcitonin · regulatory · 2026-07-28
›Summary
FDA Drug Alert dated 7/28/2026. FDA published 17 revised draft product-specific guidances (PSGs) for peptide products. The listed products include calcitonin salmon (CALCIMAR NDA 017769; MIACALCIN NDA 017808), dasiglucagon hydrochloride (ZEGALOGUE NDA 214231), glucagon (BAQSIMI NDA 210134; GLUCAGON NDA 020928; GVOKE NDA 212097), liraglutide (VICTOZA NDA 022341; SAXENDA NDA 206321), pegcetacoplan (SYFOVRE NDA 217171; EMPAVELI NDA 215014), semaglutide (OZEMPIC NDA 209637; WEGOVY NDA 215256), teriparatide (FORTEO NDA 021318; TERIPARATIDE NDA 218771), tirzepatide (MOUNJARO NDA 215866; ZEPBOUND NDA 217806) and vosoritide (VOXZOGO NDA 214938). Per FDA, the revised draft PSGs provide updated recommendations across five areas: submission of recombinantly, synthetically, or semi-synthetically produced peptides as ANDAs; innate immune response testing; impurity thresholds; higher order structure assessment; and biological activity assessment. FDA states that PSGs are published to facilitate generic drug development and streamline abbreviated new drug application (ANDA) assessment, and that when finalized these PSGs will describe the agency's current thinking on developing generic products therapeutically equivalent to these peptide products. On the same date FDA withdrew the May 2021 guidance for industry "ANDAs for Certain Highly Purified Synthetic Peptide Drug Products That Refer to Listed Drugs of rDNA Origin", stating it no longer reflects FDA's current scientific thinking, and noted a plan to revise it this year. These are draft guidances open to public comment; they are not approvals and do not change the approval status of any listed product.
CagriSema, Cagrilintide, Semaglutide, Elecoglipron · metabolic · 2026-06-05
›Summary
The American Diabetes Association's 86th Scientific Sessions run June 5-8, 2026 in New Orleans, with GLP-1-based therapies featured in seven of eight major clinical-trial result sessions. Phase 3 REIMAGINE 1, 2 and 3 data for CagriSema (cagrilintide + semaglutide, Novo Nordisk) are scheduled to be presented for the first time on Sunday, June 7. Phase 2b data for the oral small-molecule GLP-1 agonist elecoglipron (AZD5004/ECC5004) in obesity (VISTA) and type 2 diabetes (SOLSTICE) are scheduled for June 7-8. Event/agenda noted here as scheduled; per site policy no efficacy figures are recorded until primary readouts are published. Flagged for capture in the next refresh.
Retatrutide · metabolic · 2026-05-28
›Summary
Phase 3 TRANSCEND-T2D-1 (manufacturer-reported topline; Eli Lilly press release dated May 28, 2026 ahead of the ADA 86th Scientific Sessions; full results scheduled for presentation at the ADA retatrutide symposium on June 6, 2026): in adults with type 2 diabetes, retatrutide — an investigational once-weekly GIP/GLP-1/glucagon triple receptor agonist peptide — was reported to lower A1C by up to an average of 2.0% and body weight by up to an average of 36.6 lb (16.8%) at 40 weeks [human]. This is the peptide's first dedicated Phase 3 type 2 diabetes readout, complementing the obesity result in TRIUMPH-1 (ResearchArticles id 9). The figures are manufacturer-reported topline values and have not yet been peer-reviewed; retatrutide is not FDA-approved and is legally available only to participants in Lilly clinical trials. Primary source on file: PeptideSources id 37 (investor.lilly.com TRANSCEND-T2D-1 release).
Semaglutide, Tirzepatide · safety · 2026-05-23
›Summary
Peer-reviewed pharmacovigilance study (Nature Health, 2026; DOI 10.1038/s44360-026-00108-y) applying large-scale natural-language analysis to 410,198 Reddit posts (May 2019-June 2025) mentioning semaglutide or tirzepatide. Of 67,008 users who self-reported use, 43.5% described at least one side effect. Gastrointestinal symptoms predominated: nausea (36.9%), fatigue (16.7%), vomiting (16.3%), constipation (15.3%) and diarrhoea (12.6%). The study surfaced under-recognised signals not well captured in current labelling or trials, notably reproductive symptoms (e.g., menstrual irregularities) and temperature-related complaints (e.g., chills, hot flushes). Authors conclude that large-scale social-media analysis can complement traditional pharmacovigilance for detecting emerging real-world safety signals of GLP-1 receptor agonists. Reported as observational real-world safety data; no dosing guidance recorded.
Bulevirtide · antiviral · 2026-05-22
›Summary
On May 22, 2026 the FDA granted accelerated approval to Hepcludex (bulevirtide-gmod), the first and only approved US treatment for chronic hepatitis delta virus (HDV) infection in adults without cirrhosis or with compensated cirrhosis. Bulevirtide is an HBV/HDV entry inhibitor (NTCP receptor blocker), a 47-amino-acid lipopeptide given subcutaneously. Approval was based on HDV RNA reduction and ALT normalization in the Phase 3 MYR301 study; clinical-outcome benefit not yet established (confirmatory trial required).
Retatrutide, Tirzepatide, CagriSema · Weight Management & Metabolic · 2026-05-21
›Summary
Phase 3 TRIUMPH-1 (Eli Lilly press release May 21, 2026): Retatrutide 12 mg produced 28.3% body weight loss (70.3 lb) over 80 weeks in adults with obesity without T2D. 9 mg: 25.9% (64.4 lb). 4 mg: 19.0% (47.2 lb). All doses met primary and key secondary endpoints. 45.3% of 12 mg patients achieved ≥30% weight loss (bariatric-surgery threshold). 104-week extension (BMI ≥35): 30.3% (85.0 lb). Additional readouts: TRIUMPH-4 (knee OA, 28.7%), TRANSCEND-T2D-1 (2.0% HbA1c drop). LDL-C reduction ~20% is a unique mechanistic signal. FDA NDA submission anticipated Q3–Q4 2026. Drug is not yet approved.
Semaglutide, Tirzepatide, Retatrutide · safety · 2026-05-19
›Summary
Partnership for Safe Medicines May 2026 roundup documenting safety risks across the GLP-1 weight-loss market: counterfeit Ozempic/Mounjaro seizures (US, Canada, Australia, India, UK), illicit online sales of unregistered semaglutide, tirzepatide and "research-use-only" retatrutide from non-FDA-registered foreign suppliers, and mass-compounding by 503A pharmacies operating at manufacturer scale. Cites concrete patient-harm cases: a Kentucky patient requiring a liver transplant after four weeks of compounded tirzepatide/B12, a Texas death linked to compounded semaglutide/B12 (Empower Pharmacy litigation), and multiple hospitalizations. Also summarizes FDA actions: 88 warning letters since Sept 2025 over false/misleading compounded GLP-1 marketing, the proposal to exclude semaglutide/tirzepatide/liraglutide from the 503B bulks list (comment period ends June 30, 2026), and several 503B outsourcers (ProRx, BPI Labs, Medisource, Olympia) exiting GLP-1 compounding.
Tirzepatide · regulatory · 2026-05-18
›Summary
FDA issued a warning to a 503B compounding pharmacy for producing tirzepatide after the official shortage ended, consistent with the agency's April 30, 2026 proposal to exclude GLP-1 drugs from the 503B bulks list.
Semaglutide, Tirzepatide, Liraglutide · regulatory · 2026-04-30
›Summary
FDA proposed (Apr 30, 2026; Federal Register May 1, 2026) to leave semaglutide, tirzepatide, and liraglutide OFF the 503B Bulk Drug Substances List, finding no clinical need for outsourcing-facility bulk compounding now that shortages have ended. Comment period closes June 29, 2026. Affects bulk compounding only; the drugs remain FDA-approved.
GLP-1–GIP–lanifibranor, Semaglutide, Tirzepatide · metabolic · 2026-04-29
›Summary
Peer-reviewed preclinical study (Nature, published 29 April 2026; DOI 10.1038/s41586-026-10427-5; Helmholtz Munich with Indiana Biosciences Research Institute and the Novo Nordisk Research Center Indianapolis). Reports a unimolecular quintuple agonist, GLP-1–GIP–lanifibranor, a peptide-drug conjugate that covalently tethers the small-molecule PPARα/γ/δ triple agonist lanifibranor to a GLP-1R/GIPR dual-incretin peptide backbone, delivering PPAR action selectively into GLP-1R- and GIPR-expressing cells. In vitro it is indistinguishable from GLP-1–GIP in incretin-receptor signalling and insulin secretion from isolated mouse islets. In vivo in obese, insulin-resistant mice it outperformed GLP-1R–GIPR co-agonism and semaglutide, further reducing body weight, food intake and hyperglycaemia via synergistic incretin and PPAR activity; the effect was blunted by genetic or pharmacological inhibition of GLP-1R, GIPR or PPARδ and absent in double incretin-receptor-knockout mice. Authors conclude the molecule has substantial therapeutic potential for obesity-linked metabolic dysfunction. Preclinical (mouse) data only; no human or dosing guidance recorded. A Publisher Correction was issued 18 May 2026 (DOI 10.1038/s41586-026-10619-z).
BPC-157, TB-500, Semax, Epitalon, DSIP, GHK-Cu, KPV, PEG-MGF, Melanotan II, MOTS-C, LL-37, DiHexa · regulatory · 2026-04-16
›Summary
On April 15, 2026, FDA announced removal of 12 peptide bulk drug substances from Category 2 effective April 22, 2026, following withdrawal of nominations. No longer "significant safety risk" designation but not yet on 503A Bulks List. PCAC reviews July 23-24, 2026.
LL-37, GHK-Cu, Dihexa, Melanotan II · regulatory · 2026-04-15
›Summary
FDA early announcement page for a meeting of the Pharmacy Compounding Advisory Committee (PCAC), Center for Drug Evaluation and Research; page content current as of 04/15/2026. FDA states that it "will host an advisory committee meeting before the end of February 2027". Under Agenda the page states: "The Committee will discuss the following bulk drug substances being considered for inclusion on the 503A bulks list:" and lists five substances — Cathelicidin (LL-37); GHK-Cu; Dihexa acetate; Melanotan II; and Mechano Growth Factor, Pegylated (PEG-MGF). FDA states the meeting time and location "will be scheduled in the coming months", and that the public will have the option to participate via an online teleconferencing and/or video conferencing platform. FDA states it intends to make meeting materials and the link to the live webcast available no later than two business days before the meeting in the Event Materials section of that webpage, and that it intends to publish a Federal Register notice and establish a docket for public comment on this meeting in the near future. FDA states that advisory committees provide independent expert advice and make non-binding recommendations to the agency. Scope: this document announces an agenda for a future meeting. It records no vote, no committee recommendation, and no change to the regulatory status of any substance named, and it does not place any of the five substances on the 503A bulks list.
Research index (42)
Peer-reviewed studies, pharmacovigilance reports, and regulatory advisories tracked by PeptideSciences101, newest first. Each entry links to its primary source.
| Date | Category | Title & source | Peptide(s) |
|---|---|---|---|
| 2026-08-31 | studies | GLP-1 Microdosing: We Finally Have Published Data. Here's What It Actually Shows — Biology Methods and Protocols (Oxford University Press) | Semaglutide, Tirzepatide |
| A peer-reviewed retrospective electronic-health-record study compared patients with sustained prescriptions at the lowest marketed initiation doses of semaglutide (0.25 mg) and tirzepatide (2.5 mg). Using a federated EHR system covering 29 million patients, the authors identified 814 semaglutide-treated and 1,016 tirzepatide-treated patients meeting a stringent sustained low-dose prescription criterion. In matched analyses, mean 12-month weight change was -2.2% with semaglutide and -5.5% with tirzepatide. The paper also reported several higher observed adverse-event rates in the tirzepatide cohort, including constipation and acute kidney injury. Critically, the authors state that this prescribing pattern may overlap with, but does not establish, intentional microdosing. This is observational, hypothesis-generating evidence rather than a randomized test of a microdosing protocol; it does not establish causality, long-term safety, or an optimized low-dose regimen. | |||
| 2026-08-28 | regulatory | FDA Approves Mounjaro (Tirzepatide) to Reduce Cardiovascular Risk in Adults With Type 2 Diabetes — Eli Lilly and Company | Tirzepatide |
| FDA approved Mounjaro (tirzepatide) to reduce the risk of major adverse cardiovascular events (MACE) — cardiovascular death, non-fatal heart attack, or non-fatal stroke — in adults with type 2 diabetes who are at high risk for these events, based on the SURPASS-CVOT trial (13,299 adults with type 2 diabetes and established atherosclerotic cardiovascular disease across 640 sites in 30 countries). SURPASS-CVOT compared Mounjaro against Trulicity (dulaglutide), an active comparator with its own established cardiovascular benefit, and was designed as a non-inferiority trial: the hazard ratio for time to first MACE was 0.92 (95.3% CI 0.83-1.01), described by the sponsor as "non-inferiority to dulaglutide" with "an 8% lower rate" of the composite endpoint. The sponsor's release explicitly states superiority to dulaglutide was not established — the confidence interval crosses 1.00. The indication is specific to adults with type 2 diabetes at high cardiovascular risk, not a general cardiovascular-protection claim. | |||
| 2026-08-24 | regulatory | FDA Warning Letter: “Research Use Only” Labeling Did Not Override Evidence of Intended Human Drug Use — FDA Center for Drug Evaluation and Research | Tirzepatide, Semaglutide, Retatrutide, SS-31 (Elamipretide), PT-141, Tesamorelin, Ipamorelin |
| FDA issued a warning letter to Royal Peptides LLC after reviewing its website in July 2026. FDA identified products marketed as tirzepatide, semaglutide, retatrutide, SS-31 (elamipretide), PT-141, tesamorelin and a tesamorelin/ipamorelin blend (BIMORELIN) as unapproved new drugs based on evidence of intended drug use in the company's labeling and website claims. In a footnote, FDA specifically stated that despite labeling the products “for research use only” and “not for human or animal consumption,” evidence from the website established that the products were intended as drugs for human use. FDA further stated that the company marketed bacteriostatic water alongside a peptide guide and peptide calculator, resources that collectively provided the means to prepare an injectable drug for human administration. The warning letter concerns the specific products and marketing FDA reviewed; it is not a finding that legitimate scientific peptide research is unlawful. FDA warning letters describe the agency's position at the time issued and may be followed by subsequent interactions with the recipient. | |||
| 2026-07-28 | regulatory | FDA Publishes 17 Revised Draft Product-Specific Guidances for Generic Peptide Products, and Withdraws the 2021 Synthetic Peptide ANDA Guidance — FDA Center for Drug Evaluation and Research | Semaglutide, Tirzepatide, Liraglutide, Teriparatide, Calcitonin |
| FDA Drug Alert dated 7/28/2026. FDA published 17 revised draft product-specific guidances (PSGs) for peptide products. The listed products include calcitonin salmon (CALCIMAR NDA 017769; MIACALCIN NDA 017808), dasiglucagon hydrochloride (ZEGALOGUE NDA 214231), glucagon (BAQSIMI NDA 210134; GLUCAGON NDA 020928; GVOKE NDA 212097), liraglutide (VICTOZA NDA 022341; SAXENDA NDA 206321), pegcetacoplan (SYFOVRE NDA 217171; EMPAVELI NDA 215014), semaglutide (OZEMPIC NDA 209637; WEGOVY NDA 215256), teriparatide (FORTEO NDA 021318; TERIPARATIDE NDA 218771), tirzepatide (MOUNJARO NDA 215866; ZEPBOUND NDA 217806) and vosoritide (VOXZOGO NDA 214938). Per FDA, the revised draft PSGs provide updated recommendations across five areas: submission of recombinantly, synthetically, or semi-synthetically produced peptides as ANDAs; innate immune response testing; impurity thresholds; higher order structure assessment; and biological activity assessment. FDA states that PSGs are published to facilitate generic drug development and streamline abbreviated new drug application (ANDA) assessment, and that when finalized these PSGs will describe the agency's current thinking on developing generic products therapeutically equivalent to these peptide products. On the same date FDA withdrew the May 2021 guidance for industry "ANDAs for Certain Highly Purified Synthetic Peptide Drug Products That Refer to Listed Drugs of rDNA Origin", stating it no longer reflects FDA's current scientific thinking, and noted a plan to revise it this year. These are draft guidances open to public comment; they are not approvals and do not change the approval status of any listed product. | |||
| 2026-06-05 | metabolic | ADA 2026 Scientific Sessions (June 5-8, New Orleans): First-Time CagriSema REIMAGINE Phase 3 and Oral GLP-1 Readouts Scheduled — American Diabetes Association / Medscape | CagriSema, Cagrilintide, Semaglutide, Elecoglipron |
| The American Diabetes Association's 86th Scientific Sessions run June 5-8, 2026 in New Orleans, with GLP-1-based therapies featured in seven of eight major clinical-trial result sessions. Phase 3 REIMAGINE 1, 2 and 3 data for CagriSema (cagrilintide + semaglutide, Novo Nordisk) are scheduled to be presented for the first time on Sunday, June 7. Phase 2b data for the oral small-molecule GLP-1 agonist elecoglipron (AZD5004/ECC5004) in obesity (VISTA) and type 2 diabetes (SOLSTICE) are scheduled for June 7-8. Event/agenda noted here as scheduled; per site policy no efficacy figures are recorded until primary readouts are published. Flagged for capture in the next refresh. | |||
| 2026-05-28 | metabolic | Retatrutide TRANSCEND-T2D-1 Phase 3: A1C Lowered up to ~2.0% and Weight up to 16.8% at 40 Weeks in Type 2 Diabetes (Eli Lilly, ADA 2026) — Eli Lilly and Company | Retatrutide |
| Phase 3 TRANSCEND-T2D-1 (manufacturer-reported topline; Eli Lilly press release dated May 28, 2026 ahead of the ADA 86th Scientific Sessions; full results scheduled for presentation at the ADA retatrutide symposium on June 6, 2026): in adults with type 2 diabetes, retatrutide — an investigational once-weekly GIP/GLP-1/glucagon triple receptor agonist peptide — was reported to lower A1C by up to an average of 2.0% and body weight by up to an average of 36.6 lb (16.8%) at 40 weeks [human]. This is the peptide's first dedicated Phase 3 type 2 diabetes readout, complementing the obesity result in TRIUMPH-1 (ResearchArticles id 9). The figures are manufacturer-reported topline values and have not yet been peer-reviewed; retatrutide is not FDA-approved and is legally available only to participants in Lilly clinical trials. Primary source on file: PeptideSources id 37 (investor.lilly.com TRANSCEND-T2D-1 release). | |||
| 2026-05-23 | safety | Self-Reported Side Effects of Semaglutide and Tirzepatide in Online Communities (Nature Health, 2026) — Nature Health | Semaglutide, Tirzepatide |
| Peer-reviewed pharmacovigilance study (Nature Health, 2026; DOI 10.1038/s44360-026-00108-y) applying large-scale natural-language analysis to 410,198 Reddit posts (May 2019-June 2025) mentioning semaglutide or tirzepatide. Of 67,008 users who self-reported use, 43.5% described at least one side effect. Gastrointestinal symptoms predominated: nausea (36.9%), fatigue (16.7%), vomiting (16.3%), constipation (15.3%) and diarrhoea (12.6%). The study surfaced under-recognised signals not well captured in current labelling or trials, notably reproductive symptoms (e.g., menstrual irregularities) and temperature-related complaints (e.g., chills, hot flushes). Authors conclude that large-scale social-media analysis can complement traditional pharmacovigilance for detecting emerging real-world safety signals of GLP-1 receptor agonists. Reported as observational real-world safety data; no dosing guidance recorded. | |||
| 2026-05-22 | antiviral | FDA Approves First Treatment for Chronic Hepatitis Delta Virus (HDV): Hepcludex (Bulevirtide-gmod) — FDA Center for Drug Evaluation and Research | Bulevirtide |
| On May 22, 2026 the FDA granted accelerated approval to Hepcludex (bulevirtide-gmod), the first and only approved US treatment for chronic hepatitis delta virus (HDV) infection in adults without cirrhosis or with compensated cirrhosis. Bulevirtide is an HBV/HDV entry inhibitor (NTCP receptor blocker), a 47-amino-acid lipopeptide given subcutaneously. Approval was based on HDV RNA reduction and ALT normalization in the Phase 3 MYR301 study; clinical-outcome benefit not yet established (confirmatory trial required). | |||
| 2026-05-21 | Weight Management & Metabolic | Retatrutide TRIUMPH-1 Phase 3: 28.3% Weight Loss at 80 Weeks (Eli Lilly, May 2026) — Diabetes and Obesity Reviews | Retatrutide, Tirzepatide, CagriSema |
| Phase 3 TRIUMPH-1 (Eli Lilly press release May 21, 2026): Retatrutide 12 mg produced 28.3% body weight loss (70.3 lb) over 80 weeks in adults with obesity without T2D. 9 mg: 25.9% (64.4 lb). 4 mg: 19.0% (47.2 lb). All doses met primary and key secondary endpoints. 45.3% of 12 mg patients achieved ≥30% weight loss (bariatric-surgery threshold). 104-week extension (BMI ≥35): 30.3% (85.0 lb). Additional readouts: TRIUMPH-4 (knee OA, 28.7%), TRANSCEND-T2D-1 (2.0% HbA1c drop). LDL-C reduction ~20% is a unique mechanistic signal. FDA NDA submission anticipated Q3–Q4 2026. Drug is not yet approved. | |||
| 2026-05-19 | safety | Safety Risks in the GLP-1 Market: May 2026 Update on Compounded & Counterfeit Semaglutide/Tirzepatide — Partnership for Safe Medicines | Semaglutide, Tirzepatide, Retatrutide |
| Partnership for Safe Medicines May 2026 roundup documenting safety risks across the GLP-1 weight-loss market: counterfeit Ozempic/Mounjaro seizures (US, Canada, Australia, India, UK), illicit online sales of unregistered semaglutide, tirzepatide and "research-use-only" retatrutide from non-FDA-registered foreign suppliers, and mass-compounding by 503A pharmacies operating at manufacturer scale. Cites concrete patient-harm cases: a Kentucky patient requiring a liver transplant after four weeks of compounded tirzepatide/B12, a Texas death linked to compounded semaglutide/B12 (Empower Pharmacy litigation), and multiple hospitalizations. Also summarizes FDA actions: 88 warning letters since Sept 2025 over false/misleading compounded GLP-1 marketing, the proposal to exclude semaglutide/tirzepatide/liraglutide from the 503B bulks list (comment period ends June 30, 2026), and several 503B outsourcers (ProRx, BPI Labs, Medisource, Olympia) exiting GLP-1 compounding. | |||
| 2026-05-18 | regulatory | FDA Warns 503B Outsourcing Facility for Compounding Tirzepatide After Shortage Ended — Partnership for Safe Medicines | Tirzepatide |
| FDA issued a warning to a 503B compounding pharmacy for producing tirzepatide after the official shortage ended, consistent with the agency's April 30, 2026 proposal to exclude GLP-1 drugs from the 503B bulks list. | |||
| 2026-04-30 | regulatory | FDA Proposes to Exclude Semaglutide, Tirzepatide, and Liraglutide from the 503B Bulks List — FDA Center for Drug Evaluation and Research | Semaglutide, Tirzepatide, Liraglutide |
| FDA proposed (Apr 30, 2026; Federal Register May 1, 2026) to leave semaglutide, tirzepatide, and liraglutide OFF the 503B Bulk Drug Substances List, finding no clinical need for outsourcing-facility bulk compounding now that shortages have ended. Comment period closes June 29, 2026. Affects bulk compounding only; the drugs remain FDA-approved. | |||
| 2026-04-29 | metabolic | Unimolecular Quintuple Agonist GLP-1–GIP–Lanifibranor Corrects Obesity and Diabetes in Mice (Nature, 2026) — Nature | GLP-1–GIP–lanifibranor, Semaglutide, Tirzepatide |
| Peer-reviewed preclinical study (Nature, published 29 April 2026; DOI 10.1038/s41586-026-10427-5; Helmholtz Munich with Indiana Biosciences Research Institute and the Novo Nordisk Research Center Indianapolis). Reports a unimolecular quintuple agonist, GLP-1–GIP–lanifibranor, a peptide-drug conjugate that covalently tethers the small-molecule PPARα/γ/δ triple agonist lanifibranor to a GLP-1R/GIPR dual-incretin peptide backbone, delivering PPAR action selectively into GLP-1R- and GIPR-expressing cells. In vitro it is indistinguishable from GLP-1–GIP in incretin-receptor signalling and insulin secretion from isolated mouse islets. In vivo in obese, insulin-resistant mice it outperformed GLP-1R–GIPR co-agonism and semaglutide, further reducing body weight, food intake and hyperglycaemia via synergistic incretin and PPAR activity; the effect was blunted by genetic or pharmacological inhibition of GLP-1R, GIPR or PPARδ and absent in double incretin-receptor-knockout mice. Authors conclude the molecule has substantial therapeutic potential for obesity-linked metabolic dysfunction. Preclinical (mouse) data only; no human or dosing guidance recorded. A Publisher Correction was issued 18 May 2026 (DOI 10.1038/s41586-026-10619-z). | |||
| 2026-04-16 | regulatory | FDA Announces Removal of 12 Peptides from Category 2 — April 15, 2026 — Orrick, Herrington & Sutcliffe LLP | BPC-157, TB-500, Semax, Epitalon, DSIP, GHK-Cu, KPV, PEG-MGF, Melanotan II, MOTS-C, LL-37, DiHexa |
| On April 15, 2026, FDA announced removal of 12 peptide bulk drug substances from Category 2 effective April 22, 2026, following withdrawal of nominations. No longer "significant safety risk" designation but not yet on 503A Bulks List. PCAC reviews July 23-24, 2026. | |||
| 2026-04-15 | regulatory | FDA Early Announcement: Pharmacy Compounding Advisory Committee to Consider LL-37, GHK-Cu, Dihexa Acetate, Melanotan II and PEG-MGF for the 503A Bulks List Before the End of February 2027 — FDA Center for Drug Evaluation and Research | LL-37, GHK-Cu, Dihexa, Melanotan II |
| FDA early announcement page for a meeting of the Pharmacy Compounding Advisory Committee (PCAC), Center for Drug Evaluation and Research; page content current as of 04/15/2026. FDA states that it "will host an advisory committee meeting before the end of February 2027". Under Agenda the page states: "The Committee will discuss the following bulk drug substances being considered for inclusion on the 503A bulks list:" and lists five substances — Cathelicidin (LL-37); GHK-Cu; Dihexa acetate; Melanotan II; and Mechano Growth Factor, Pegylated (PEG-MGF). FDA states the meeting time and location "will be scheduled in the coming months", and that the public will have the option to participate via an online teleconferencing and/or video conferencing platform. FDA states it intends to make meeting materials and the link to the live webcast available no later than two business days before the meeting in the Event Materials section of that webpage, and that it intends to publish a Federal Register notice and establish a docket for public comment on this meeting in the near future. FDA states that advisory committees provide independent expert advice and make non-binding recommendations to the agency. Scope: this document announces an agenda for a future meeting. It records no vote, no committee recommendation, and no change to the regulatory status of any substance named, and it does not place any of the five substances on the 503A bulks list. | |||
| 2026-04-15 | regulatory | FDA Confirms 7-Peptide Agenda for July 23–24, 2026 PCAC 503A Bulks-List Review (BPC-157, KPV, TB-500, MOTS-C, DSIP/Emideltide, Semax, Epitalon) — U.S. Food and Drug Administration — Advisory Committee Calendar | BPC-157, KPV, TB-500, MOTS-C, DSIP (Emideltide), Semax, Epitalon |
| FDA primary source (Pharmacy Compounding Advisory Committee meeting notice; page content current as of 2026-04-15). The PCAC will meet July 23–24, 2026 at FDA White Oak Campus to discuss bulk drug substances nominated for inclusion on the Section 503A Bulks List. The confirmed agenda covers SEVEN peptides — not all twelve that were removed from Category 2 on April 22, 2026. Day 1 (July 23): BPC-157 (free base / acetate) — use evaluated: ulcerative colitis; KPV (free base / acetate) — wound healing and inflammatory conditions; TB-500 (free base / acetate) — wound healing; MOTS-C (free base / acetate) — obesity and osteoporosis. Day 2 (July 24): Emideltide / delta sleep-inducing peptide (DSIP) (free base / acetate) — opioid withdrawal, chronic insomnia, and narcolepsy; Semax (free base / acetate) — cerebral ischemia, migraine, and trigeminal neuralgia; Epitalon (free base / acetate) — insomnia. The listed conditions are the nominated uses FDA reviewed for each substance; they are not FDA endorsements of efficacy. PCAC recommendations are non-binding and inclusion on the 503A Bulks List has not been decided. The other five peptides removed from Category 2 in April 2026 (PEG-MGF, Melanotan II, LL-37, DiHexa, and injectable GHK-Cu) are NOT on this July agenda; their compounding status remains unresolved (they are not on the 503A Bulks List). Public docket: FDA-2025-N-6895. Comments received on or before July 9, 2026 will be provided to the Committee; the docket closes July 22, 2026. Requests to make oral presentations are due June 30, 2026. Factual regulatory reporting only; no efficacy or compounding-permission is asserted. | |||
| 2026-04-09 | safety | Health Canada Public Advisory (RA-81874): Unauthorized Injectable Peptide Drugs Sold Online May Cause Serious Harm — Health Canada | BPC-157, TB-500, Retatrutide, CJC-1295, DSIP, Epitalon, GHK-Cu, Ipamorelin, KPV, Melanotan I/II, MOTS-C, NAD+, SS-31, HCG |
| Health Canada public advisory (RA-81874, published 2026-04-09) warning consumers about serious health risks of unauthorized injectable peptide drugs sold online and marketed for anti-aging, weight loss, bodybuilding, athletic performance, injury recovery, sleep, mental focus, or general wellness. Health Canada has seized multiple such products and lists examples: BPC-157, CJC-1295, DSIP, Epitalon, GHK-Cu, HCG, Ipamorelin, KPV, Melanotan I and II, MOTS-C, NAD+, SS-31, TB-500, and Retatrutide, noting many other unauthorized peptide drugs exist. In Canada peptides are generally regulated as prescription drugs. Unauthorized products are illegal, have not been assessed for safety, efficacy or quality, and may contain too much, too little, none of, or unlisted/dangerous ingredients, as well as contaminants (solvents, heavy metals, particulates, microbials). Stated risks include hormonal imbalance, mood swings, blood sugar imbalance, liver or kidney damage, blood clots, growth of cancerous tumours, infections and allergic reactions. The agency stresses that "For Research Use Only - Not for Human Consumption" labelling does not make these products legal, and is working with the Canada Border Services Agency to stop unauthorized shipments. Recorded as a regulatory safety advisory; no dosing or usage guidance stored. | |||
| 2026-04-01 | metabolic | FDA Novel Drug Approval: Foundayo (Orforglipron) — First Oral GLP-1 Agonist — FDA Center for Drug Evaluation and Research | Orforglipron |
| FDA approved Foundayo (orforglipron) April 1, 2026. First oral GLP-1 receptor agonist for weight management in adults with obesity or overweight. Eli Lilly. | |||
| 2026-03-19 | regulatory | FDA Approves Higher-Dose Wegovy HD (Semaglutide 7.2 mg) Under National Priority Voucher Program — U.S. Food and Drug Administration | Semaglutide |
| FDA approved Wegovy HD (semaglutide injection, 7.2 mg), a higher-dose formulation, to reduce excess body weight and maintain weight reduction long-term in adults with obesity, or overweight with at least one weight-related condition. This was the fourth approval granted under the FDA Commissioner's National Priority Voucher program, which allowed an expedited review timeline. FDA noted it is investigating reports of altered skin sensation occurring more frequently at this higher dose. | |||
| 2026-03-17 | immune | FDA Novel Drug Approval: Icotyde (Icotrokinra) — First Oral Peptide for Plaque Psoriasis — FDA Center for Drug Evaluation and Research | Icotrokinra |
| FDA approved Icotyde (icotrokinra) March 17, 2026. First-in-class oral macrocyclic peptide IL-23R antagonist for moderate-to-severe plaque psoriasis. J&J / Protagonist Therapeutics. | |||
| 2026-02-27 | bone | FDA Novel Drug Approval: Yuviwel (Navepegritide) — CNP Analog for Achondroplasia — FDA Center for Drug Evaluation and Research | Navepegritide |
| FDA approved Yuviwel (navepegritide) Feb 27, 2026 for pediatric achondroplasia. PEGylated CNP analog activating NPR-B to promote bone growth. BioMarin. | |||
| 2026-02-23 | metabolic | FDA Novel Drug Approval: Loargys (Pegzilarginase-nbln) — Enzyme for Arginase 1 Deficiency — FDA Center for Drug Evaluation and Research | Pegzilarginase-nbln |
| FDA approved Loargys (pegzilarginase-nbln) Feb 23, 2026. PEGylated arginase enzyme for Arginase 1 Deficiency. IV infusion with dietary protein restriction. | |||
| 2026-01-13 | safety | FDA Requests Removal of Suicidal Behavior and Ideation Warning from Glucagon-Like Peptide-1 Receptor Agonist (GLP-1 RA) Medications — FDA Center for Drug Evaluation and Research | Semaglutide, Tirzepatide, Liraglutide |
| FDA Drug Safety Communication dated 01-13-2026, updating FDA's communication of January 30, 2024. FDA is requesting that drug application holders remove information regarding the risk of suicidal ideation and behavior (SI/B) from the labeling of GLP-1 receptor agonist medications that currently include such language; the affected products named are Saxenda (liraglutide), Wegovy (semaglutide) and Zepbound (tirzepatide). FDA states the request follows a comprehensive review that found no increased risk of SI/B. That review comprised a meta-analysis of 91 placebo-controlled GLP-1 RA trials including 107,910 patients (60,338 treated with a GLP-1 RA, 47,572 with placebo), whose results did not show an increased risk of SI/B or of anxiety, depression, irritability or psychosis; and a retrospective cohort study in the FDA Sentinel System of 2,243,138 new users (1,161,983 initiated on a GLP-1 RA, 1,081,155 on an SGLT2 inhibitor) across 10 data partners between October 1, 2015 and September 20, 2023, which after controlling for baseline confounders did not find an increased risk of intentional self-harm. FDA's stated conclusion is that the totality of the studies reviewed does not support a causal relationship between GLP-1 RA use and SI/B. Scope: the action concerns labeling for the three named products approved for weight reduction. FDA notes that labeling for GLP-1 RA medications approved to improve glycemic control in type 2 diabetes did not carry the SI/B language, and that similar SI/B language appears in the labeling of other weight-loss medicines based on events observed with older agents. | |||
| 2025-12-22 | regulatory | FDA Approves Wegovy (Semaglutide) Tablets, the First Oral GLP-1 for Weight Management — Novo Nordisk | Semaglutide |
| FDA approved Wegovy (semaglutide) tablets, an oral once-daily 25 mg formulation, for chronic weight management in adults with obesity or overweight and at least one weight-related condition, and for reduction of major adverse cardiovascular events in adults with overweight or obesity and established cardiovascular disease, alongside diet and physical activity. Efficacy is based on the OASIS 4 trial (16.6% mean weight loss among adherent participants). Novo Nordisk's own release states this is the first and only oral GLP-1 receptor agonist approved for weight loss in adults — a peptide oral formulation, distinct from later oral small-molecule GLP-1 agonists. | |||
| 2025-11-08 | cardiometabolic | Enlicitide Decanoate (Oral Macrocyclic Peptide PCSK9 Inhibitor) Reduced LDL-C 55.8% in Phase 3 CORALreef Lipids (Merck, AHA 2025) — Merck (MSD) | Enlicitide decanoate (MK-0616) |
| Investigational once-daily ORAL macrocyclic peptide PCSK9 inhibitor (Merck/MSD; MK-0616). Late-breaking Phase 3 CORALreef Lipids results presented at AHA Scientific Sessions 2025 (announced 8 Nov 2025): in adults with or at risk for atherosclerotic cardiovascular disease on background lipid-lowering therapy, enlicitide reduced LDL-C by 55.8% vs placebo at week 24 (primary analysis; 95% CI -60.9 to -50.7; p<0.001), with statistically significant reductions sustained through week 52. Overall safety profile comparable to placebo; discontinuations due to adverse events were low and similar (enlicitide 3.1% vs placebo 4.1%). Enlicitide is an oral macrocyclic peptide that blocks the PCSK9-LDL-receptor interaction (the same biological target as injectable anti-PCSK9 monoclonal antibodies) and would be the first oral PCSK9 inhibitor if approved. FDA granted it a Commissioner's National Priority Voucher (Dec 2025); Merck has stated it expects to file for FDA approval in 2026. Investigational, not FDA-approved. Factual trial-outcome reporting only; no dosing guidance recorded. | |||
| 2025-08-15 | regulatory | FDA Grants Accelerated Approval to Wegovy (Semaglutide) for MASH With Liver Fibrosis — Novo Nordisk | Semaglutide |
| FDA granted Wegovy (semaglutide) 2.4 mg accelerated approval to treat adults with metabolic dysfunction-associated steatohepatitis (MASH) with moderate-to-advanced liver fibrosis, but not cirrhosis, alongside a reduced-calorie diet and increased physical activity. The approval is based on improvement of MASH and liver fibrosis; per FDA and the sponsor, an ongoing study is required to confirm clinical benefit, and continued approval for this indication may depend on that confirmatory trial. This is the first FDA liver-disease indication for a GLP-1 receptor agonist. The indication is narrow — noncirrhotic MASH with fibrosis stage F2-F3 specifically, not MASH or liver disease generally. | |||
| 2025-01-28 | regulatory | FDA Approves Ozempic (Semaglutide) to Reduce Chronic Kidney Disease Progression — Novo Nordisk | Semaglutide |
| FDA approved Ozempic (semaglutide) for a third indication: to reduce the risk of kidney disease worsening, kidney failure (end-stage kidney disease), and death due to cardiovascular disease in adults with type 2 diabetes and chronic kidney disease, based on the FLOW trial. This indication is specific to adults who have both type 2 diabetes and chronic kidney disease, not chronic kidney disease generally, and is in addition to Ozempic's existing glycemic-control and cardiovascular-risk-reduction indications. | |||
| 2025-01-15 | regulatory | FDA Pharmacy Compounding Advisory Committee Final Summary Minutes (October 29, 2024): Committee Voted Against Adding Ipamorelin, Ibutamoren Mesylate and Kisspeptin-10 to the 503A Bulks List — U.S. Food and Drug Administration — Pharmacy Compounding Advisory Committee | Ipamorelin, MK-677 (Ibutamoren), Kisspeptin |
| Final Summary Minutes of the FDA Pharmacy Compounding Advisory Committee (PCAC) meeting held October 29, 2024 at the FDA White Oak Campus; minutes approved January 15, 2025. The Committee discussed bulk drug substances being considered for inclusion on the 503A Bulks List. FDA proposed that each substance NOT be included, and the Committee voted on that proposal. Recorded vote results: Ibutamoren mesylate (uses evaluated: growth hormone deficiency, osteoporosis, hip fracture, sarcopenia, obesity, Alzheimer's disease) — Yes 1, No 13, Abstain 0. Ipamorelin (free base) (uses evaluated: growth hormone deficiency and postoperative ileus) — Yes 0, No 12, Abstain 1. Ipamorelin acetate — Yes 0, No 12, Abstain 1. Kisspeptin-10 (use evaluated: secondary hypogonadism in men) — Yes 0, No 11, Abstain 0. L-theanine, also on the agenda, is not a catalogued compound. On Ipamorelin the minutes state that members voting "No" "agreed that there was a lack of information supporting safety and efficacy shown in the available data". On Ibutamoren mesylate they state that members voting "No" "mentioned that the evidence presented did not support clinical efficacy and safety" and "expressed concerns over the adverse effects reported including fluid retention, congestive heart failure, and hyperglycemia". On Kisspeptin-10 they state the Committee "unanimously agreed that Kisspeptin-10 should not be included on the 503A Bulks List due to the lack of convincing safety and efficacy data". FDA states that advisory committees make non-binding recommendations, which the agency generally follows but is not legally bound to do so. Note on substance scope: the votes were taken on Ibutamoren mesylate and on Kisspeptin-10 specifically; the corresponding catalog entries are MK-677 (Ibutamoren) and the broader Kisspeptin. This entry records the Committee's recorded votes and FDA's published minutes only; it is not a statement about the efficacy, safety, or legal status of any compound. | |||
| 2024-12-20 | regulatory | FDA Approves Zepbound (Tirzepatide) as First Prescription Medicine for Obstructive Sleep Apnea — Eli Lilly and Company | Tirzepatide |
| FDA approved Zepbound (tirzepatide) as the first and only prescription medicine for moderate-to-severe obstructive sleep apnea (OSA) in adults with obesity, based on the SURMOUNT-OSA trials. Reported results: reductions of roughly 25-29 apnea-hypopnea events per hour versus about 5-6 on placebo, alongside mean body-weight reductions of 18-20%. The indication is specific to adults who have both obesity and OSA, not OSA generally, and is used alongside a reduced-calorie diet and increased physical activity. | |||
| 2024-06-01 | Performance & Growth | Peptide Therapy in Sports Medicine: Current Evidence and Future Directions — Sports Medicine | BPC-157, TB-500, Ipamorelin, CJC-1295 |
| Critical review of peptide use in athletic recovery: available evidence, WADA prohibited status, ethical considerations. | |||
| 2024-03-15 | Performance & Growth | Growth Hormone Secretagogues: Peptide and Non-Peptide Options in 2024 — Growth Hormone and IGF Research | Ipamorelin, CJC-1295, Sermorelin, MK-677 |
| Comprehensive comparison of GHRH analogs, GHRPs, and ghrelin mimetics for clinical and off-label applications. | |||
| 2024-03-08 | regulatory | FDA Approves Wegovy (Semaglutide) for Cardiovascular Risk Reduction — Novo Nordisk | Semaglutide |
| FDA approved Wegovy (semaglutide) 2.4 mg for an additional indication: to reduce the risk of major cardiovascular events (cardiovascular death, non-fatal heart attack, or non-fatal stroke) in adults with known cardiovascular disease and either obesity or overweight, based on the SELECT trial (n=17,604). This is a risk-reduction indication for adults with established cardiovascular disease, not a general treatment claim for heart disease, and it is in addition to Wegovy's existing chronic weight-management indication. | |||
| 2024-02-01 | Weight Management & Metabolic | Oral Peptides and GLP-1 Analogs: Breaking the Injection Barrier — Drug Discovery Today | Orforglipron, Semaglutide (oral) |
| Review of advances in oral peptide bioavailability: Rybelsus SNAC technology, orforglipron, next-generation oral metabolic agents. | |||
| 2024-01-15 | Healing & Recovery | BPC-157: A Comprehensive Overview of the Research Evidence — Examine.com Research Digest | BPC-157 |
| Comprehensive review of BPC-157 preclinical evidence, proposed mechanisms, dosing, and limitations of available human data. | |||
| 2023-09-01 | Weight Management & Metabolic | The GLP-1 Revolution: How Semaglutide and Tirzepatide Are Reshaping Obesity Medicine — Endocrine Society News | Semaglutide, Tirzepatide |
| Overview of GLP-1/GIP receptor agonist landscape, efficacy comparison, and future directions including oral formulations and triple agonists. | |||
| 2023-06-01 | Cognitive Enhancement | Russian Nootropic Peptides: Semax and Selank in Clinical Practice — Neurochemistry International | Semax, Selank, NA-Semax-Amidate |
| Clinical review of Russian peptide nootropics: regulatory approval, mechanism, and comparative analysis. | |||
| 2023-05-01 | Hormonal | Melanocortin Peptides in Sexual Medicine: PT-141 and Melanotan II — Sexual Medicine Reviews | PT-141, Melanotan II |
| Review of MC-receptor agonists for sexual dysfunction: PT-141 FDA approval for HSDD, off-label erectile use, Melanotan II safety concerns. | |||
| 2022-09-01 | Anti-aging & Longevity | Mitochondrial Peptides and the Future of Aging Research — Nature Aging | MOTS-c, Humanin, SS-31 |
| Comprehensive review of mitochondria-derived peptides as a new class of longevity therapeutics. | |||
| 2020-02-21 | regulatory | FDA Approves Trulicity (Dulaglutide) to Reduce Cardiovascular Events in Type 2 Diabetes — Eli Lilly and Company | Dulaglutide |
| FDA approved Trulicity (dulaglutide) for reduction of major adverse cardiovascular events (MACE) — nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death — in adults with type 2 diabetes who have established cardiovascular disease or multiple cardiovascular risk factors, based on the REWIND trial. The sponsor describes this as the first approval of a type 2 diabetes medicine for MACE reduction covering both primary and secondary prevention populations; reported risk reduction was approximately 12%. Most REWIND participants did not have established cardiovascular disease at baseline, so the population includes both risk-factor-only and established-disease patients. | |||
| 2014-02-01 | Cosmetic & Skin | GHK-Cu: More Than a Skin Peptide - Systemic Applications in Aging — Cosmetics | Copper Peptide GHK-Cu |
| Expanding GHK-Cu beyond dermatology: gene expression modulation, anti-cancer effects, wound healing, systemic administration. | |||
| 2013-01-01 | Immune Support | The Thymosin Family: Biological and Clinical Significance — Annals of the New York Academy of Sciences | Thymosin Alpha-1, Thymosin Beta-4 |
| Review of thymosin class peptides: alpha-1 immune modulation and clinical approvals, beta-4 tissue repair. | |||
| 2012-11-01 | Anti-aging & Longevity | Peptide Bioregulators: Khavinsons Life Work on Aging and Longevity — Aging Research Reviews | Epitalon, Thymalin, Vilon |
| Review of 40+ years of Khavinsons peptide bioregulators: mechanism, clinical applications, and longevity data. | |||
External literature search
For comprehensive searches across the biomedical literature, the following resources are authoritative:
- PubMed — NIH-maintained index of biomedical research.
- DailyMed — FDA-curated drug labelling.
- ClinicalTrials.gov — Registry of clinical trials.
- FDA Drugs@FDA — Approved drug records.
How we cite
Every claim on PeptideSciences101 should link to an authoritative source. Sources are catalogued in our PeptideSources table with type tagging (e.g. systematic_review, randomized_trial, observational), an authority score, and the date last accessed. References appear as superscript numbers in articles linking to the bibliography at the bottom.
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