Liver and lipids
Thirteen molecules with two-digit PubMed article counts and outcome trials of up to 17,300 participants — and only one of them, inclisiran, has active registration
Experimental material. Read before using anything from here.
Nothing on this page is a medical recommendation, prescription or treatment plan. It is an organized translation of protocols circulating in research communities and, where it exists, of what published trials tested. The two are marked differently — and they are not equivalent.
Most of the compounds here have no FDA approval for human use. Several are sold labeled "research use only", which means they have not gone through purity, sterility or dosage controls for human consumption. A community-reported dose is not a validated dose: it is what someone reported having done.
Talk to a licensed health professional before considering any of these compounds. If you already use one and feel anything unexpected, seek care — do not wait for the next routine test.
Summary
Two shelves that conversation about metabolic conditions tends to lump together, and that aren't the same thing: the steatohepatitis drugs — resmetirom, the three FGF21 analogs, lanifibranor, denifanstat — and the lipid drugs that statins don't reach — inclisiran, pelacarsen, olpasiran, lepodisiran, muvalaplin, obicetrapib, plus zilebesiran, which is the same technology but targets blood pressure. What unites them is the scale of the trial. The literature is small — the median for this table is in the tens of articles — and the registrations are enormous: the largest one I opened, for lepodisiran, declares 17,300 participants. It's the inverse of the pattern for the rest of this site, where article volume is large and the outcome trial doesn't exist.
Why liver and lipids belong on a peptide site
They're included for two reasons. The first is that retatrutide and survodutide, which this site already covers, are also studied for the liver — and anyone searching for “peptide for liver fat” ends up on these molecules without realizing they've changed category.
The second is more important. These thirteen programs are the best ruler available for what this site demands from the rest: a large trial, with a hard outcome, registered before it began. Four of them declare more than seven thousand participants. No community compound on this site comes close to that, and the difference isn't one of degree.
A note on method: the searches use each molecule's INN, without commercial synonyms. Where the molecule still had a development code in use — the case of CT-388, now enicepatide, which is on the incretins page — the code goes into the query. Here it wasn't necessary.
No number on this page came from the site's secondary source.
How much evidence exists, compound by compound
The numbers below were compiled by me on September 12, 2026, on PubMed and ClinicalTrials.gov. Each row's query is written out in full, next to the number, so anyone can repeat it and contradict me — and so the script that rechecks this site's counts can run all of them.
The condition column is not a claim about mechanism: it's the Condition field copied from the phase 3 records that the search itself returned. When there is no phase 3 record, the cell says so.
| Compound | Condition in phase 3 registrations | Query | Articles in PubMed | Studies on ClinicalTrials.gov |
|---|---|---|---|---|
| Resmetirom | Non-Alcoholic Fatty Liver Disease; NASH - Nonalcoholic Steatohepatitis | resmetirom | 487 | 22 |
| Efruxifermin | NASH/MASH; NAFLD/MASLD; NASH - Nonalcoholic Steatohepatitis; MASH - Metabolic Dysfunction-Associated Steatohepatitis | efruxifermin | 45 | 6 |
| Pegozafermin | Metabolic Dysfunction-Associated Steatotic Liver Disease (MASH) / Nonalcoholic Steatohepatitis (NASH) With Fibrosis; Metabolic Dysfunction-Associated Steatohepatitis (MASH) / Nonalcoholic Steatohepatitis (NASH) With Compensated Cirrhosis; Severe Hypertriglyceridemia | pegozafermin | 32 | 6 |
| Efimosfermin | Non-alcoholic Fatty Liver Disease; Metabolic Dysfunction-associated Steatohepatitis | efimosfermin | 9 | 9 |
| Lanifibranor | NASH - Nonalcoholic Steatohepatitis | lanifibranor | 77 | 7 |
| Denifanstat | MASH; NASH; Metabolic Dysfunction-associated Steatohepatitis; Acne | denifanstat | 19 | 7 |
| Inclisiran | Heterozygous or Homozygous Familial Hypercholesterolemia; ASCVD; Elevated Cholesterol; Hypercholesterolemia | inclisiran | 745 | 81 |
| Pelacarsen | Atherosclerotic Cardiovascular Disease; Atherosclerotic Cardiovascular Disease (ASCVD); Hyperlipoproteinemia(a) | pelacarsen | 90 | 14 |
| Olpasiran | Atherosclerotic Cardiovascular Disease; Cardiovascular Disease | olpasiran | 82 | 9 |
| Lepodisiran | Atherosclerotic Cardiovascular Disease (ASCVD); Elevated Lp(a); Atherosclerosis; Cardiovascular Diseases | lepodisiran | 54 | 3 |
| Muvalaplin | Elevated Lp(a); Atherosclerotic Cardiovascular Disease (ASCVD) | muvalaplin | 34 | 1 |
| Obicetrapib | Lipidemia; Type 2 Diabetes (T2DM); Metabolic Syndrome (MetS); Coronary Artery Disease | obicetrapib | 88 | 21 |
| Zilebesiran | High Risk Cardiovascular Disease; Hypertension; High Cardiovascular Risk | zilebesiran | 53 | 7 |
What exists in phase 3, and who it belongs to
Article count measures academic attention, not outcome evidence. The table below separates what has a registered phase 3 trial — and shows the largest registration the search returned in each row, with the declared number of participants and the sponsor.
A registration is not a result. A recruiting phase 3 trial is declared intent with money behind it, and nothing more than that.
| Compound | Query | Registered phase 3 trials | The largest registration I opened |
|---|---|---|---|
| Resmetirom | (resmetirom) AND AREA[Phase]PHASE3 | 4 | NCT03900429 · n = 1,759 · Madrigal Pharmaceuticals, Inc. NASH - Nonalcoholic Steatohepatitis |
| Efruxifermin | (efruxifermin) AND AREA[Phase]PHASE3 | 3 | NCT06528314 · n = 2,150 · Akero Therapeutics, Inc NASH - Nonalcoholic Steatohepatitis, MASH - Metabolic Dysfunction-Associated Steatohepatitis |
| Pegozafermin | (pegozafermin) AND AREA[Phase]PHASE3 | 3 | NCT06318169 · n = 1,350 · 89bio, Inc. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASH) / Nonalcoholic Steatohepatitis (NASH) With Fibrosis |
| Efimosfermin | (efimosfermin) AND AREA[Phase]PHASE3 | 4 | NCT07221188 · n = 1,250 · GlaxoSmithKline Non-alcoholic Fatty Liver Disease |
| Lanifibranor | (lanifibranor) AND AREA[Phase]PHASE3 | 1 | NCT04849728 · n = 1,000 · Inventiva Pharma NASH - Nonalcoholic Steatohepatitis |
| Denifanstat | (denifanstat) AND AREA[Phase]PHASE3 | 4 | NCT06248008 · n = 240 · Ascletis Pharmaceuticals Co., Ltd. Acne |
| Inclisiran | (inclisiran) AND AREA[Phase]PHASE3 | 24 | NCT03399370 · n = 1,561 · The Medicines Company ASCVD, Elevated Cholesterol |
| Pelacarsen | (pelacarsen) AND AREA[Phase]PHASE3 | 8 | NCT06875973 · n = 599 · Novartis Pharmaceuticals Atherosclerotic Cardiovascular Disease |
| Olpasiran | (olpasiran) AND AREA[Phase]PHASE3 | 3 | NCT07136012 · n = 11,000 · Amgen Cardiovascular Disease |
| Lepodisiran | (lepodisiran) AND AREA[Phase]PHASE3 | 2 | NCT06292013 · n = 17,300 · Eli Lilly and Company Atherosclerotic Cardiovascular Disease (ASCVD), Elevated Lp(a) |
| Muvalaplin | (muvalaplin) AND AREA[Phase]PHASE3 | 1 | NCT07157774 · n = 10,450 · Eli Lilly and Company Elevated Lp(a), Atherosclerotic Cardiovascular Disease (ASCVD) |
| Obicetrapib | (obicetrapib) AND AREA[Phase]PHASE3 | 7 | NCT06005597 · n = 407 · NewAmsterdam Pharma Dyslipidemias, Hypercholesterolemia, Familial Hypercholesterolemia |
| Zilebesiran | (zilebesiran) AND AREA[Phase]PHASE3 | 1 | NCT07181109 · n = 11,000 · Alnylam Pharmaceuticals High Risk Cardiovascular Disease, Hypertension, High Cardiovascular Risk |
Where the numbers don't add up
- The four largest registrations on this page add up to more than forty thousand participants. Lepodisiran (17,300), zilebesiran (11,000), muvalaplin (10,450), and olpasiran (7,297). These are cardiovascular outcome trials, the most expensive and slowest design that exists — and the reason none of them has an answer yet.
- Inclisiran is the only one with a package insert in Brazil. 1 active registration, under the name SYBRAVA, in the antilipemics class. The other twelve have none.
- Resmetirom has 487 articles and 4 phase 3 trials, the two largest with 1,343 and 810 participants, sponsored by Madrigal. It's the line with the most published evidence in the liver block — and still has no active registration.
- The three FGF21 analogs add up to 86 articles on PubMed and 10 phase 3 trials. A vial of “research FGF21” is none of the three: what's in trials is an engineered fusion protein, with a sponsor and a registration number.
- Denifanstat has one phase 3 registration with declared enrollment of zero. Among the 4 that the search returns, the first one I opened, from Sagimet, declares zero participants. Phase 3 count isn't a count of people.
In Brazil
I searched every active ingredient in the open data on registered medicines, downloaded on September 12, 2026 — 43,508 rows, counting only Active status. The therapeutic class column is the one the dataset itself declares for the product.
Twelve of the thirteen rows come back empty. That doesn't mean the molecule is prohibited: it means it isn't a medicine here yet, and that there's no legal product to buy with that active ingredient.
| Active ingredient | Search pattern | Active registrations | Declared therapeutic class | Products |
|---|---|---|---|---|
| Resmetirom | RESMETIROM | 0 | — | — |
| Efruxifermin | EFRUXIFERMIN | 0 | — | — |
| Pegozafermin | PEGOZAFERMIN | 0 | — | — |
| Efimosfermin | EFIMOSFERMIN | 0 | — | — |
| Lanifibranor | LANIFIBRANOR | 0 | — | — |
| Denifanstat | DENIFANSTAT | 0 | — | — |
| Inclisiran | INCLISIRAN | 1 | ANTILIPEMICOS | SYBRAVA |
| Pelacarsen | PELACARSEN | 0 | — | — |
| Olpasiran | OLPASIRAN | 0 | — | — |
| Lepodisiran | LEPODISIRAN | 0 | — | — |
| Muvalaplin | MUVALAPLIN | 0 | — | — |
| Obicetrapib | OBICETRAPIB | 0 | — | — |
| Zilebesiran | ZILEBESIRAN | 0 | — | — |
References
- Public ClinicalTrials.gov API, version 2 — the source for all the study and phase 3 counts on this page.
- PubMed E-utilities (esearch) — the basis for all article counts on this page.
- NCT06292013 registration on ClinicalTrials.gov — lepodisiran, 17,300 participants, sponsored by Eli Lilly. The largest trial on this page.
- NCT07181109 registration on ClinicalTrials.gov — zilebesiran, 11,000 participants, sponsored by Alnylam.
- NCT05581303 registration on ClinicalTrials.gov — olpasiran, 7,297 participants, sponsored by Amgen.
- NCT04197479 registration on ClinicalTrials.gov — resmetirom, 1,343 participants, sponsored by Madrigal Pharmaceuticals.