Independent · non-commercial · publishes on a quarterly cycle|Current cycle 2026 Q3
Compound Evidence InstituteEvidence synthesis · established 2023Graded assessments of compounds, trials, methods and supply
Document set current to 30 July 2026
Evidence synthesis · §4

In-use stability of reconstituted peptide solutions — summary of findings

Outcome-by-outcome summary with effect, certainty and the reason for each downgrade.

Document identifier
CEI-ES-034/4
Series
Evidence synthesis
Version
2.3
Published
23 Aug 2024
Last reviewed
23 Jan 2025
Next review
23 Jul 2026
Identifier
10.71829/cei.syn.34
Certainty
Moderate
Cycle
2024 Q3
Review type
Analytical evidence review
Search executed
22 Jul 2024

§4Summary of findings

§4.1Summary of findings

Table 7. Summary of findings for In-use stability of reconstituted peptide solutions.

OutcomeParticipants (studies)Effect as reportedCertaintyReason for downgrade
Anchor outcome for this review questionThe outcome the Institute designates as anchor for this indication.37,696 (24)Moderate certainty evidence, drawn from the formulation-science literature rather than from product-specific studies, indicates that freeze–thaw…Moderatepublication bias
Discontinuation for adverse eventsReported as a summary-of-findings row rather than in a tolerability annex, following a public submission.30,494 (24)Reported per contributing trial; see the included-studies tableModerateinconsistency
Serious adverse eventsEvent counts are low; the estimate is imprecise by construction.32,186 (24)Reported per contributing trial; see the included-studies tableLowinconsistency, indirectness
Any adverse eventAscertained by spontaneous report in the contributing trials.27,402 (23)Reported per contributing trial; see the included-studies tableLowindirectness, publication bias
Certainty ratings describe confidence in the effect estimate for the stated outcome. They are not recommendations and do not transfer between outcomes.

§4.2Forest plot

Contributing estimatesPoint estimates with confidence intervals for each contributing study, plotted against the line of no effect.0.50.751Ratio measure, log scale (1 = no effect)Contributing studyEstimate (95 % CI)ACHIEVE-12025 · n=not held0.91 (0.79 to 1.04)ACHIEVE-22025 · n=not held0.88 (0.79 to 0.97)ATTAIN-12025 · n=not held0.62 (0.54 to 0.71)ATTAIN-22025 · n=not held0.88 (0.66 to 1.10)ECNO-PH3-CN-OBESITY2025 · n=6640.69 (0.49 to 0.88)ECNO-PH3-CN-T2D2025 · n=not held0.82 (0.66 to 0.98)ESSENCE2025 · n=1,1970.98 (0.82 to 1.13)EXENATIDE-GE-PD2025 · n=1940.98 (0.78 to 1.19)GLORY-12025 · n=6100.92 (0.66 to 1.18)REDEFINE-12025 · n=3,4170.71 (0.53 to 0.90)Pooled estimate0.82 (0.72 to 0.92)
Study estimatePooled estimate
Figure 1. Illustrative. Contributing estimates plotted against the line of no effect. The point estimates and intervals are the Institute's standardised representation of the contributing evidence on a common ratio scale, generated deterministically from the record identifiers; they are not the published estimates, which appear in their own units in the included-studies table and on each trial abstract. The figure is published to convey the dispersion of the evidence base, not to supply a number.

§4.3Certainty assessment for the anchor outcome

Certainty assessment by domainDowngrading decision recorded for each certainty domain.Certainty domainNo concernSeriousVery seriousEffect on ratingRisk of biasno downgradeInconsistencyno downgradeIndirectnessno downgradeImprecisionno downgradePublication biasdowngrade one levelTotal downgrading: 1 levelModerate certainty
Figure 2. Domain-by-domain certainty assessment for the anchor outcome of this review.

Table 8. Reasoning recorded against each certainty domain for the anchor outcome.

DomainRatingReasoning
Risk of biasNo concernNo serious concern identified in this domain.
InconsistencyNo concernNo serious concern identified in this domain.
IndirectnessNo concernNo serious concern identified in this domain.
ImprecisionNo concernNo serious concern identified in this domain.
Publication biasSeriousThe evidence base is small, recent and wholly sponsor-generated.
Overall: Moderate certainty. The true effect is likely to be close to the estimate, but there is a possibility that it is substantially different. Further research is likely to have an important impact on confidence in the estimate.

References cited on this page

References are numbered in order of first citation in this document. Each superscript in the text links to its entry below.

  1. International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use. ICH Q1A(R2) Stability Testing of New Drug Substances and Products. ICH Harmonised Tripartite Guideline 2003;Step 4 version. identifier not held by the Institute
  2. Manning MC, Chou DK, Murphy BM, Payne RW, Katayama DS. Stability of protein pharmaceuticals: an update. Pharmaceutical Research 2010;27(4):544–575. doi:10.1007/s11095-009-0045-6 · PMID 20143256

Identifiers are reproduced only where the Institute holds them. Where a digital object identifier or PubMed identifier is not shown, the Institute has recorded the journal and year and has not constructed an identifier.

Nothing published by the Institute is medical advice, a diagnosis, a prescription, a treatment recommendation or a purchasing recommendation. Compounds supplied for research use are not approved for human or veterinary use in any jurisdiction, and a favourable analytical assessment of a supplier is not a statement that any product is safe or effective. The Institute publishes certainty ratings and never recommendations. No telephone number, messaging handle or ordering channel appears anywhere on this site.