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Compounds · Secretagogues & GH axis

CJC-1295 with and without DAC: what the modification does

MS
m.strand_rphTL3Pharmacist16 Feb 2026#1

On the subject in the title: CJC-1295 with and without DAC: what the modification does Working notes rather than a conclusion.

Comparing PIONEER 6 (N Engl J Med, 2019) with SURMOUNT-OSA (N Engl J Med, 2024) and finding the comparison harder than it looks.

Different populations, different durations, different endpoints defined slightly differently, and in one case a different estimand. People compare the headline percentages anyway, including me until recently.

Is there a defensible way to put these side by side, or is the honest answer that there is not and we should stop?

30 likes 5mo
NC
n.cabreraTL2 Moderator20 Feb 2026 · edited#2

Two things before anyone answers the substance.

First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound.

31 likes 5mo
DH
dietitian_hollisTL3Dietitian23 Feb 2026#3
n.cabrera, post #2: Two things before anyone answers the substance. First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound. Go to post

Reading a rodent study on a secretagogue without over-extrapolating: rodent studies can show a mechanism is plausible. They cannot show magnitude of effect in humans or safety profile in humans. That gap is larger for secretagogues than for incretin agonists because the human evidence is thinner.

0 likes in reply to #2 5mo
EH
e.halonenTL2 Moderator25 Feb 2026#4
dietitian_hollis, post #3: Reading a rodent study on a secretagogue without over-extrapolating: rodent studies can show a mechanism is plausible. They cannot show magnitude of effect in humans or safety profile in humans. That gap is larger for secretagogues than for incretin agonists because the human evidence is thinner. Go to post

Worth separating two things that post #3 runs together.

What a well-designed human trial of a secretagogue would look like: randomised, placebo-controlled, adequate sample size, IGF-1 as primary outcome, muscle and strength as secondary outcomes, adequate follow-up duration. Very few secretagogue trials meet that description.

3 likes in reply to #3 5mo
NE
n.ekstromTL2Regular27 Feb 2026#5

Picking up post #2: that is the part I would want checked first.

For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use.

22 likes 5mo
CC
c.castellanosTL2 Moderator2 Mar 2026#6

Coming back to post #4, because the follow-up matters more than the original answer.

Why this subcategory is stricter about sourcing than most: the evidence base is weaker and that is precisely why documentation quality matters more. A supplier page that clearly identifies the compound and the purity is more valuable for secretagogues than for incretin agonists where the evidence base is stronger.

0 likes 5mo
SS
steady_stateTL3Regular4 Mar 2026#7
e.halonen, post #4: Worth separating two things that post #3 runs together. What a well-designed human trial of a secretagogue would look like: randomised, placebo-controlled, adequate sample size, IGF-1 as primary outcome, muscle and strength as secondary outcomes, adequate follow-up duration. Very few secretagogue trials meet that description. Go to post

Development history is more informative than speculation: ipamorelin was investigated clinically for post-operative ileus and was not taken forward to registration. That it was not brought to market tells you something about the cost-benefit calculation that any amount of forum enthusiasm does not.

1 like in reply to #4 5mo
SV
s.vukovicTL2 Moderator5 Mar 2026#8

Evidence quality in the secretagogue literature is honestly weaker than in the incretin literature. Large randomised controlled trials are rare. Most evidence is mechanistic or from small studies. This is why this subcategory has higher sourcing standards than most.

6 likes 5mo
BN
bench_notesTL4 Moderator7 Mar 2026 · edited#9

GHRH analogues versus ghrelin mimetics are often conflated but they are different mechanisms. GHRH analogues (like CJC-1295) cause the pituitary to release growth hormone. Ghrelin mimetics (like GHRPs) act on the ghrelin receptor directly. The effect on growth hormone secretion is similar but the mechanisms are distinct.

30 likes 5mo
SC
s.cabreraTL2 Moderator9 Mar 2026#10
dietitian_hollis, post #3: Reading a rodent study on a secretagogue without over-extrapolating: rodent studies can show a mechanism is plausible. They cannot show magnitude of effect in humans or safety profile in humans. That gap is larger for secretagogues than for incretin agonists because the human evidence is thinner. Go to post

I read post #8 twice before replying, because I had assumed the opposite.

Tesamorelin has an approved indication in HIV-associated lipodystrophy. That is the only compound in this class with a registration-quality evidence base from a proper trial programme. Generalising from that narrow population to healthy adults is a substantial extrapolation.

0 likes in reply to #3 5mo
SP
s.poulsenTL3Regular11 Mar 2026#11

Worth separating two things that post #7 runs together.

Pulsatile secretion matters because growth hormone is secreted in pulses, not continuously. A single post-dose growth hormone level is nearly uninterpretable. Assessing this class properly requires serial sampling or an integrated measure like IGF-1, and almost nothing published online does either.

1 like 5mo
ET
e.tammTL2 Moderator13 Mar 2026#12

post #11 is right about the mechanism and I think understates the practical bit.

Secretagogues and glucose tolerance: there is a mechanistic concern that sustained growth hormone elevation might impair glucose tolerance. The clinical relevance of this concern in practice is not well established.

0 likes 5mo
M
MSaarinenTL3Regular14 Mar 2026#13

IGF-1 as a surrogate: it is a better integrated measure than a spot growth hormone level and it is still a surrogate, with all the caveats that come with surrogates. Stable or rising IGF-1 is not the same as "this is working" in any health-related sense.

16 likes 4mo
EK
e.krastevTL216 Mar 2026#14
V
VThorvaldsenTL3Regular18 Mar 2026#15

On post #11 — agreed on the reasoning, with one qualification.

Ipamorelin selectivity claims originate in preclinical characterisation and are reasonably well supported for what they claim: less effect on cortisol and prolactin than earlier GHRPs. Whether that translates to something clinically meaningful is a different question from whether the selectivity is real.

0 likes 4mo
IR
i.rasmussenTL2 Moderator19 Mar 2026#16

CJC-1295 with and without DAC: the version with a drug affinity complex binds albumin covalently and persists for days. The version without it does not persist. Supplier labelling frequently does not distinguish them clearly, so confirming which you have is important.

31 likes 4mo
K
KnowltonTL3Regular21 Mar 2026#17

What a well-designed human trial of a secretagogue would look like: randomised, placebo-controlled, adequate sample size, IGF-1 as primary outcome, muscle and strength as secondary outcomes, adequate follow-up duration. Very few secretagogue trials meet that description.

10 likes 4mo
IB
i.brobergTL2 Moderator23 Mar 2026 · edited#18
Knowlton, post #17: What a well-designed human trial of a secretagogue would look like: randomised, placebo-controlled, adequate sample size, IGF-1 as primary outcome, muscle and strength as secondary outcomes, adequate follow-up duration. Very few secretagogue trials meet that description. Go to post

Reading a rodent study on a secretagogue without over-extrapolating: rodent studies can show a mechanism is plausible. They cannot show magnitude of effect in humans or safety profile in humans. That gap is larger for secretagogues than for incretin agonists because the human evidence is thinner.

3 likes in reply to #17 4mo
SS
s.silvaTL2 Moderator24 Mar 2026#19

Two things before anyone answers the substance.

First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound.

5 likes 4mo
EK
e.kimaniTL2 Moderator26 Mar 2026#20

Ipamorelin selectivity claims originate in preclinical characterisation and are reasonably well supported for what they claim: less effect on cortisol and prolactin than earlier GHRPs. Whether that translates to something clinically meaningful is a different question from whether the selectivity is real.

1 like 4mo
ZN
z.nakamuraTL2 Moderator27 Mar 2026#21

Secretagogues and glucose tolerance: there is a mechanistic concern that sustained growth hormone elevation might impair glucose tolerance. The clinical relevance of this concern in practice is not well established.

0 likes 4mo
I
IbrahimoviTL2Member29 Mar 2026 · edited#22

On post #18 — agreed on the reasoning, with one qualification.

Why this subcategory is stricter about sourcing than most: the evidence base is weaker and that is precisely why documentation quality matters more. A supplier page that clearly identifies the compound and the purity is more valuable for secretagogues than for incretin agonists where the evidence base is stronger.

2 likes 4mo
AW
am.wikstromTL2 Moderator30 Mar 2026#23
e.krastev, post #14: Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up. Go to post

I disagree with the reply above, and I think the disagreement is substantive rather than terminological.

The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient.

9 likes in reply to #14 4mo
CN
cannula_notesTL2Member1 Apr 2026#24

Development history is more informative than speculation: ipamorelin was investigated clinically for post-operative ileus and was not taken forward to registration. That it was not brought to market tells you something about the cost-benefit calculation that any amount of forum enthusiasm does not.

21 likes 4mo
BB
b.brandtTL2 Moderator2 Apr 2026#25

Evidence quality in the secretagogue literature is honestly weaker than in the incretin literature. Large randomised controlled trials are rare. Most evidence is mechanistic or from small studies. This is why this subcategory has higher sourcing standards than most.

0 likes 4mo
M
MSaarinenTL3Regular4 Apr 2026#26

GHRH analogues versus ghrelin mimetics are often conflated but they are different mechanisms. GHRH analogues (like CJC-1295) cause the pituitary to release growth hormone. Ghrelin mimetics (like GHRPs) act on the ghrelin receptor directly. The effect on growth hormone secretion is similar but the mechanisms are distinct.

5 likes 4mo
TL
t.lindqvistTL2 Moderator5 Apr 2026#27
e.krastev, post #14: Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up. Go to post

This follows post #24 rather than contradicting it.

Tesamorelin has an approved indication in HIV-associated lipodystrophy. That is the only compound in this class with a registration-quality evidence base from a proper trial programme. Generalising from that narrow population to healthy adults is a substantial extrapolation.

14 likes in reply to #14 4mo
JD
j.delacroixTL3Regular7 Apr 2026#28

Pulsatile secretion matters because growth hormone is secreted in pulses, not continuously. A single post-dose growth hormone level is nearly uninterpretable. Assessing this class properly requires serial sampling or an integrated measure like IGF-1, and almost nothing published online does either.

29 likes 4mo
GT
g.tammTL2 Moderator8 Apr 2026#29

For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use.

2 likes 4mo
N
NorringtonTL39 Apr 2026#30