Vial Guide

Research and regulatory digest

What changed each month for the compounds on Vial Guide: new trial results, approvals and other regulator actions, compounding and enforcement, and sport rules. Changes to the site itself are in the Updates log.

News isn’t advice. A company announcement or conference abstract hasn’t been peer reviewed, and a single trial rarely settles a question. Each compound’s page puts its news in context.

October 2026 22

Covers September 1, 2026 to October 8, 2026.

Obesity drugs dominated September and early October: phase 3 papers for retatrutide and survodutide, new amylin results for petrelintide, eloralintide and CagriSema, and phase 3 starts for petrelintide and amycretin (zenagamtide).

WADA’s 2027 list, out September 21, names SLU-PP-332 and spells out that unapproved peptides fall under S0.

FDA kept pressing “research use only” peptide sellers and pharmacies compounding copies of approved GLP-1 drugs.

Regulators and approvals

Icotrokinra pill approved in the EU and JapanThe European Commission authorized Icotyde (icotrokinra), a daily peptide pill that blocks the receptor for IL-23, an inflammation signal, on September 18 for moderate-to-severe plaque psoriasis in adults and in teens 12 and older weighing at least 40 kg. Japan approved it September 16 for plaque, pustular and erythrodermic psoriasis when existing treatments fall short.On Vial Guide: IcotrokinraEMA: Icotyde (icotrokinra), marketing authorisation issued September 18, 2026; PMDA list of new drug approvals, September 2026: Icotyde tablets 200 mg (approved September 16, 2026)

Compounding and enforcement

Two charged in an alleged counterfeit Ozempic smuggling schemeFederal prosecutors in Florida charged two people with conspiracy and smuggling over counterfeit Ozempic allegedly obtained in China and sold to US distributors at deep discounts from July 2023 to April 2024, continuing after FDA’s December 2023 warning. FDA’s criminal investigators assisted. An indictment is an allegation, not proof of guilt.On Vial Guide: SemaglutideFDA press announcement: investigation leads to charges in a transnational counterfeit Ozempic scheme (September 29, 2026)
FDA warns compounder that vitamin-added semaglutide and tirzepatide are copiesIn a warning letter dated September 18 and posted September 22, FDA told a Texas compounding pharmacy that its semaglutide and tirzepatide injections with added vitamin B12 or niacinamide appeared to be essentially copies of approved drugs, made in volumes suggesting the differences were “pretextual”. It also cited conditions that put sterile products at risk.On Vial Guide: Semaglutide, TirzepatideFDA warning letter to a Texas 503A compounding pharmacy (dated September 18, 2026; posted September 22, 2026)
CDC links illnesses to supplement-grade glutathione injectionsCDC reported more than 25 people sick in Texas, Washington, Florida and New York after injections compounded from dietary supplement-grade glutathione, likely from endotoxin, a bacterial toxin; at least 3 were hospitalized after IV doses. In September FDA also classed a Texas pharmacy’s recall of glutathione vials as Class I, its most serious level, for failed endotoxin tests.On Vial Guide: GlutathioneCDC: illnesses linked to injectable glutathione compounded with a dietary supplement-grade ingredient (updated September 11, 2026); FDA enforcement report: Class I recall of glutathione 200 mg/mL multidose vials (September 2026)
FDA warns five online sellers of research-labeled peptidesFDA posted warning letters, dated August 24, to five online sellers of “research use only” injectables, including semaglutide, tirzepatide, retatrutide, survodutide, mazdutide, SS-31, tesamorelin and PT-141. FDA called them unapproved new drugs: website evidence showed human use despite the disclaimers, including bacteriostatic water sold alongside peptide calculators and guides.On Vial Guide: Semaglutide, Tirzepatide, Retatrutide, Survodutide, Mazdutide, SS-31, Tesamorelin, PT-141, Tesamorelin + IpamorelinFDA warning letters to five online peptide sellers (issued August 24, 2026; posted September 1, 2026)

Sport

WADA’s 2027 list names SLU-PP-332 as a banned metabolic modulatorWADA’s 2027 Prohibited List, published September 21 and in force January 1, 2027, adds “SLU-PP-332, SLU-PP-915 and related substances” to section S4.4.1, metabolic modulators banned at all times. Under the current 2026 list it falls only under S0, the catch-all for unapproved drugs. S4.4 substances are “non-Specified”, unlike those in S0, which matters when sanctions are set.On Vial Guide: SLU-PP-332WADA 2027 Prohibited List, section S4.4.1 (published September 21, 2026); WADA 2027 Summary of Major Modifications and Explanatory Notes
WADA’s 2027 list spells out peptides; GLP-1 drugs stay allowedSection S0 (non-approved substances) now lists “peptides” among its examples, alongside the already named BPC-157; WADA notes that unnamed peptides may also fall under S2 or S4. The S2 peptide-hormone section is unchanged. Semaglutide and tirzepatide stay on the 2027 Monitoring Program, not banned, while WADA runs two studies in athletes.On Vial Guide: BPC-157, Semaglutide, TirzepatideWADA 2027 Prohibited List, section S0, and 2027 Summary of Major Modifications and Explanatory Notes; WADA 2027 Monitoring Program; WADA news release: WADA publishes 2027 Prohibited List (September 21, 2026)

Trial results

NAD+ precursor pill fails in early Parkinson’s disease trialIn a Norwegian phase 3 trial, 410 people with early Parkinson’s took oral nicotinamide riboside, a supplement that raises NAD+, or placebo for 52 weeks. Symptom scores worsened 2.72 points more on the supplement, and non-motor symptoms worsened more too. Serious health problems occurred in 8.3% vs 14.1%. It tested a pill, not injected NAD+.On Vial Guide: NAD+Brakedal et al., NOPARK trial of nicotinamide riboside in early Parkinson disease (JAMA 2026), PMID 42848371
Petrelintide phase 2 results in type 2 diabetes announcedZealand Pharma announced 28-week phase 2 results (ZUPREME-2) in 220 adults with overweight or obesity and type 2 diabetes. Weight fell 7.4–9.2% on three weekly doses, not yet disclosed, vs 2.0% on placebo, if everyone had stayed on treatment. HbA1c, a 3-month blood sugar average, fell up to 0.65 points vs a 0.23 rise.On Vial Guide: PetrelintideZealand Pharma company announcement: ZUPREME-2 phase 2 topline results (October 7, 2026); ZUPREME-2 trial record (ClinicalTrials.gov), NCT06926842
Chemically made semaglutide matches Wegovy in a Chinese phase 3 trialIn a 44-week open-label trial in China, 462 adults with obesity took weekly HD1916, a chemically synthesized semaglutide, or brand-name Wegovy. Mean weight fell 13.1% vs 14.4%, a gap inside the preset margin for counting the two as equivalent, and side effects were similar. The abstract doesn’t say whether everyone randomized was counted.On Vial Guide: SemaglutideGao et al., HD1916 vs semaglutide (Wegovy) phase 3 equivalence trial in Chinese adults with obesity (Diabetes Obes Metab 2026), PMID 42839752
Survodutide phase 3 results in type 2 diabetes publishedSYNCHRONIZE-2 was published in NEJM and presented at the EASD diabetes meeting: 752 adults with obesity or overweight and type 2 diabetes, 76 weeks. Weight fell 8.2–9.8% vs 3.9% on placebo, whether or not people stayed on treatment; the companies reported up to 13.1% vs 3.1% if all had. Stomach side effects made 18% stop vs 1.2%.On Vial Guide: SurvodutideWharton et al., survodutide once weekly in adults with obesity and type 2 diabetes, SYNCHRONIZE-2 (NEJM 2026), PMID 42820639; Zealand Pharma company announcement No. 52/2026: Boehringer Ingelheim’s SYNCHRONIZE-2 results (October 1, 2026)
Semaglutide kidney trial misses its main MRI goalsIn a 52-week trial of 106 adults with type 2 diabetes and chronic kidney disease, weekly semaglutide didn’t change kidney oxygen levels, blood flow or inflammation on MRI compared with placebo, the main goals. Secondary results pointed to lower resistance in the kidney arteries and less progression of scarring. The trial studied how it protects kidneys, not whether.On Vial Guide: SemaglutideTuttle et al., effects of semaglutide on kidney disease in type 2 diabetes, randomized placebo-controlled trial (Nat Med 2026), PMID 42823485
Eloralintide plus tirzepatide beats tirzepatide alone in type 2 diabetesEli Lilly announced 48-week phase 2b results, presented at the EASD diabetes meeting, in 367 adults with obesity or overweight and type 2 diabetes. The combination lowered weight up to 23.3% vs 14.8% on tirzepatide 15 mg and 3.0% on placebo, if all had stayed on treatment; eloralintide alone gave 8.2–12.3%. Lilly plans phase 3 in late 2026.On Vial Guide: Eloralintide, TirzepatideEli Lilly press release: EloraTZP phase 2b results in obesity and type 2 diabetes (September 30, 2026); Phase 2b trial record (ClinicalTrials.gov), NCT06603571
Orforglipron heart-safety trial published in The LancetACHIEVE-4 gave 2,749 adults with type 2 diabetes at high heart risk daily orforglipron or insulin glargine for a median 2 years. Heart attack, stroke, heart death or hospital care for unstable angina occurred in 4.2% vs 5.0%, meeting the goal of being no worse than insulin. Clinically significant low blood sugar was 6.8% vs 19.2%.On Vial Guide: OrforglipronKlein et al., cardiovascular safety of orforglipron vs insulin glargine, ACHIEVE-4 (Lancet 2026), PMID 42815506
Retatrutide’s TRIUMPH-1 and TRIUMPH-2 phase 3 trials publishedIn TRIUMPH-1 (NEJM; 2,339 adults with obesity, no diabetes), weight fell 17.6%, 23.7% and 25.0% on three weekly doses vs 3.9% on placebo at 80 weeks. In TRIUMPH-2 (Lancet; 1,152 adults with type 2 diabetes), it fell 11.9–18.8% vs 5.1%. Both count everyone randomized. Eli Lilly said it plans to file with FDA in early 2027.On Vial Guide: RetatrutideJastreboff et al., retatrutide for treatment of obesity, TRIUMPH-1 (NEJM 2026), PMID 42814954; Bellido et al., retatrutide in adults with obesity and type 2 diabetes, TRIUMPH-2 (Lancet 2026), PMID 42810372; Eli Lilly press release: TRIUMPH-2 results at EASD and filing plans (September 29, 2026)
Petrelintide’s ZUPREME 1 phase 2 trial published in fullLancet Diabetes & Endocrinology published ZUPREME 1: 493 adults with obesity but no diabetes, treated for 42 weeks. At 28 weeks, weight fell 7.9–9.8% on five weekly maintenance doses vs 1.7% on placebo, if everyone had stayed on treatment, and up to 10.7% by week 42. Nausea, mostly mild and during dose steps, affected 20% vs 6%.On Vial Guide: PetrelintideGarvey et al., petrelintide ZUPREME 1 phase 2 trial (Lancet Diabetes Endocrinol 2026), PMID 42810355
VK2735 kept most weight off with less frequent dosesViking Therapeutics announced results in about 180 adults with obesity. Weekly injections for 21 weeks cut weight about 16–19%. Over the next 12 weeks, people dosed every other week kept 83–97% of that loss and those dosed monthly 82–90%, vs 61% after switching to placebo, counting those treated and weighed in that phase. Stomach side effects then matched placebo.On Vial Guide: VK2735Viking Therapeutics press release: maintenance study top-line results (September 22, 2026)
Lower-dose CagriSema beats tirzepatide 5 mg in phase 3Novo Nordisk announced two phase 3 results for CagriSema (cagrilintide with semaglutide) at 1.0 mg of each. With type 2 diabetes (REIMAGINE 5), weight fell 12.4% vs 9.1% on tirzepatide 5 mg at 60 weeks; in obesity (REDEFINE 9), 21.0% vs 2.0% on placebo at 68 weeks, if all had stayed on treatment. FDA’s decision is expected late 2026.On Vial Guide: Cagrilintide, Semaglutide, TirzepatideNovo Nordisk announcement: REIMAGINE 5 and REDEFINE 9 topline results, Capital Markets Day (September 21, 2026)
Cochrane review finds weak evidence for thymosin alpha-1 in hepatitis BA Cochrane review pooled 10 randomized trials, with 1,349 adults, of thymosin alpha-1 for chronic hepatitis B, published 1991–2018. It may roughly halve deaths (risk ratio 0.53, three trials), but the evidence was very low certainty for every outcome except serious adverse events (low), so the authors can’t say whether it helps. They found no ongoing trials.On Vial Guide: Thymosin Alpha-1Naing et al., thymosin alpha-1 for people with chronic hepatitis B (Cochrane Database Syst Rev 2026), PMID 42713852

New trials and filings

Amycretin (zenagamtide) adds head-to-head and heart-outcome phase 3 trialsNovo Nordisk’s AMAZE 7 began September 22, comparing weekly amycretin injections with semaglutide in about 650 adults with obesity, no diabetes, over 84 weeks. On October 6, AMBIENCE appeared on ClinicalTrials.gov: about 8,500 adults with overweight or obesity and artery disease, amycretin vs placebo, counting heart attacks, strokes, heart deaths and heart failure events. It isn’t recruiting yet.On Vial Guide: Amycretin, SemaglutideAMAZE 7 trial record (ClinicalTrials.gov, start September 22, 2026), NCT07668414; AMBIENCE trial record (ClinicalTrials.gov, first posted October 6, 2026), NCT07861100
VK2735 maintenance study adds tablet arms in part 2Viking Therapeutics announced the start of part 2 of its maintenance study, in about 195 adults with obesity. After 21 weeks of weekly injections, people switch to daily or weekly VK2735 tablets, monthly or every-other-week injections, or placebo until week 33. Viking expects results in 2027; its two 78-week phase 3 trials are fully enrolled.On Vial Guide: VK2735Viking Therapeutics press release: start of the VK2735 oral maintenance dosing study (October 6, 2026)
Petrelintide enters phase 3 with three ZUPREME trialsZealand Pharma announced that it and Roche had started ZUPREME, placebo-controlled phase 3 trials in about 7,000 adults with overweight or obesity: without diabetes (ZUPREME-3), with type 2 diabetes (ZUPREME-4) and with heart or blood vessel disease (ZUPREME-5). Each measures weight change at 64 weeks. Registry records list September 30 starts for ZUPREME-3 and -5.On Vial Guide: PetrelintideZealand Pharma press release: start of the phase 3 ZUPREME program (September 22, 2026); ZUPREME-3 trial record (ClinicalTrials.gov), NCT07843498; ZUPREME-5 trial record (ClinicalTrials.gov), NCT07843472

About this digest

Each month the editors check regulators (FDA, the EMA and others), WADA, PubMed, ClinicalTrials.gov and drug makers’ announcements for news about the 123 compounds on Vial Guide. 22 items have been logged so far. Results known only from a company announcement or a conference abstract say so.

When the news changes a compound’s status, results or trials, its page is updated the same month and shows the item under Status. Changes to the site itself, such as new pages and corrections, are listed in Updates.

By Vial Guide editorsLast reviewed

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