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

Analytical surveys of unregulated peptide supply — summary of findings

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

Document identifier
CEI-ES-015/4
Series
Evidence synthesis
Version
2.2
Published
31 Aug 2026
Last reviewed
31 Aug 2026
Next review
02 Mar 2028
Identifier
10.71829/cei.syn.15
Certainty
Low
Cycle
2026 Q3
Review type
Analytical evidence review
Search executed
30 Jun 2026

§4Summary of findings

§4.1Summary of findings

Table 7. Summary of findings for Analytical surveys of unregulated peptide supply.

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)Low certainty evidence from a small number of analytical surveys indicates that identity is usually confirmed for the principal high-volume compounds…Lowrisk of bias, indirectness
Discontinuation for adverse eventsReported as a summary-of-findings row rather than in a tolerability annex, following a public submission.36,250 (23)Reported per contributing trial; see the included-studies tableLowindirectness, publication bias
Serious adverse eventsEvent counts are low; the estimate is imprecise by construction.33,983 (24)Reported per contributing trial; see the included-studies tableVery lowrisk of bias, indirectness, imprecision
Any adverse eventAscertained by spontaneous report in the contributing trials.32,525 (24)Reported per contributing trial; see the included-studies tableVery lowrisk of bias, indirectness, imprecision
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 held0.81 (0.59 to 1.03)ACHIEVE-22025 · n=not held0.77 (0.58 to 0.95)ATTAIN-12025 · n=not held0.72 (0.53 to 0.90)ATTAIN-22025 · n=not held0.82 (0.68 to 0.97)ECNO-PH3-CN-OBESITY2025 · n=6641.11 (0.95 to 1.28)ECNO-PH3-CN-T2D2025 · n=not held0.59 (0.44 to 0.75)ESSENCE2025 · n=1,1970.52 (0.43 to 0.61)EXENATIDE-GE-PD2025 · n=1940.83 (0.69 to 0.97)GLORY-12025 · n=6100.75 (0.59 to 0.91)REDEFINE-12025 · n=3,4170.64 (0.56 to 0.72)Pooled estimate0.74 (0.65 to 0.84)
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 biasdowngrade one levelInconsistencyno downgradeIndirectnessdowngrade one levelImprecisionno downgradePublication biasno downgradeTotal downgrading: 2 levelsLow 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 biasSeriousContributing trials are sponsor-conducted and one is open-label.
InconsistencyNo concernNo serious concern identified in this domain.
IndirectnessSeriousThe comparator differs across contributing trials.
ImprecisionNo concernNo serious concern identified in this domain.
Publication biasNo concernNo serious concern identified in this domain.
Overall: Low certainty. Confidence in the effect estimate is limited. The true effect may be substantially different from 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. Sodhi M, Rezaeianzadeh R, Kezouh A, Etminan M. Risk of gastrointestinal adverse events associated with glucagon-like peptide-1 receptor agonists for weight loss. JAMA 2023;330(18):1795–1797. doi:10.1001/jama.2023.19574 · PMID 37796527
  2. Carvalho M, Dinis-Oliveira RJ. Analytical and forensic aspects of counterfeit peptide hormones. Drug Testing and Analysis 2023;15(1):5–19. doi:10.1002/dta.3379

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.