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In the head-to-head SURMOUNT-5 trial (NEJM, 2025), tirzepatide produced 20.2% body weight loss vs 13.7% for semaglutide at 72 weeks, with similar side-effect profiles
The medullary thyroid carcinoma signal observed in rodent studies at supratherapeutic doses has not been confirmed in human populations across approximately eight years of post-market surveillance, but the contraindication in patients with relevant personal or family history remains appropriate
This adds another layer of complexity to dosage calculations, because timing, potential interactions, and total injection volume all need consideration
Tier 2 (promising but unproven): Cerebrolysin for optic neuroprotection based on multiple small human trials plus consistent animal data
Real-World Example: BPC-157 Positive Test In 2023, a professional combat sport athlete was suspended for two years after testing positive for BPC157, even though the peptide was claimed to be legal by the supplier
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