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- Hacker News
- I think as long as you dont copy the exact 39 amino acid structure of Retatrutide, and dont use the word "Retatrutide" to describe it, you'll be outside the lawsuit targets of Eli Lilly. You'd want to improve the structure in some way, possibly by reducing the GI effects, as an example:
retatrutide sequence: YAQGTFTSDYSILLDKKAQAAFIEYLLEGGPSSGAPPPS
modified sequence to reduce GI symptoms: YAQGTFTSDYSILLDKKAHAAFIEYLLEGGPSSGAPPPS
The difference is in spot 18, where it swaps the alanine with a histidine, which may reduce GI effects/nausea.
reference: https://doi.org/10.7554/elife.68719
Another improvement might be to add amylin/calcitonin receptor agonist to the sequence (similar to cagrilintide). (reference: https://www.nejm.org/doi/full/10.1056/NEJMoa2502081)
by jijji - Looks interesting. What's your plan on the legal front? Bet the company on the compounding lawsuits breaking in your favor, or do you have a backup plan?
BTW: when you say you manufacture the drugs, I assume that means you're buying from an API supplier, but do you actually mean you're synthesizing it yourself?
by zachthewf - Fascinating. I work in this space sort of, there's still a ton I don't understand. What is the legal space like? Are you at risk of being shut down on a dime if the FDA decides Lilly can meet demand? Are you able to compound small molecules legally like orfoglipron? Are you only going after tirzepatide, or are mono agonists too available to justify? Are you ready for the retatrutide gold rush when that gets approved?
My experience with semaglutide has been incredible. I went on it to help lose weight while waiting 6 months to get an appliance for newly diagnosed sleep apnea. My primary care didn't have appetite to prescribe it so I went through a telehealth. The telehealth at least gets you a prescription but it's a really impersonal funnel. Then you get locked into a really rigid process. The 1.5 mg oral was amazing. But then I hit the plateau. The obvious things to do was up the dose. I did that - the next dose was 4 mg and after a couple weeks had total gastroparesis and vomiting for 1-2 weeks. During this time I couldn't take the drugs, had to drop the dose to titrate back up, and gained some weight back over the next month or so. I was able to up the dose again but you can't cut the pills due to the coating so I instead alternated 1.5 mg and 4 mg pills for a couple weeks. I had to do this by not taking the 1.5 mg pills for a few weeks to build up enough of a reserve. The company I was using was totally inflexible with regard to helping me gradually ramp the dose up. The alternating eventually got me to 4 mg and I was steady on that for a while but ultimately had a couple incidents of puking. I really need something like a 3mg pill. I tried skipping a day every few because the long half life should in theory make that a reasonable way to lower the daily average dose, but then the food noise comes right back. I really need like a 3 mg pill but I cannot get one. I decided that I was done with it and went to cancel but found out that if I cancel early I need to pay $450 cancellation fee. :)
Despite having a PhD and working in obesity drug r&d I have found this one of the most complicated, stupidly inflexible, frustrating spaces I've ever seen. If I'm getting my ass kicked like this, I can only imagine what everyone else is experiencing.
The frustrating thing is I really want to be on this drug. I have latent/sub clinical HS which results in chronic low grade armpit pain - I have not had that on glp1s, my sleep apnea has improved, I've lost weight, my anxiety and ADHD have improved. But I just can't get the right dose.
by colingauvin - This is a fantastic idea and could do a lot of real good. Any plans to get your hands on a distribution agreement for small molecule or peptide oral formulations?
I write a GLP1 newsletter and would love to learn more about what you’re building and how you see the landscape.
Reta looks like it will make it out by early next year but I personally think they’ll squeeze in to end of this year — there will likely never be a undersupply of GLP1s again and I wonder if the customization loopholes will hold (Lilly will certainly fight Reta compounders harder than they have others), interested to hear your thoughts and chat.
by glp1guide - Off by one letter compared to "Roman", which is a GLP prescriber farm, but you already knew this :). Hoping for a lawsuit to boost your fame?by ipsum2
- Hey, I love the idea and the fully integrated approach! The feedback loop sounds great, and overall far better than the pretty generic companies I've dealt with for GLP before.
I've led building an EHR totally from scratch at one company and currently advising another as they build their EHR, both totally integrated approaches in industries where you usually have lots of disconnected care (adolescent serious mental illness and ABA/autism care). The state-by-state regulatory challenges are very real! If you want to chat, my email is in my profile!
by joshgachnang - I think most people on gray market GLPs will vary their dose, take tolerance breaks, etc to meet their personal weight loss goals, this stuff isn't that complicated. Where I think where the real technology opportunity is, is having a personalized endocrinologist for TRT/HRT. Bodybuilders have incredibly sophisticated trackers with hormone/ester PK models and the ability to adjust and tune your personal model based on bloodwork results. Most men's clinic, online or in person, are nowhere near as advanced. Prescribing for most of these guys is binary, or adjusting your dose is something that's done in response to some sort of a problem like hematocrit or gyno, rather than trying to keep levels in-line with whatever health goal you have. I don't think most guys really need the full TRT dose of 140 mg/week to feel energetic again, but depending on your fitness goals you can go well beyond that safely as long as you are paying close attention. There have been a couple of "high tech HRT" apps but I don't think they are really all that sophisticated, maybe daily dosing or includes a tasso device or whatever, but nothing afaik with multi-hormone PK modeling and testing feedback, so it could be right up your alley.
- You know the answer was obvious and I didn’t think to submit this to ycombinator since the idea is basically you’re front running a compounding pharmacies. This is combining a compounding pharmacy and an MSO.
At the same time, nothing is stopping you from hiring a fractional medical director and doctors alongside NP. I ran the numbers and 50k is is all you need to get a service agreement with a compounding pharmacy, back office tasks, incorporation, social media marketing policy to essentially drop ship your product as you use off the shelf products for charting and then begin expanding state coverage.
The July Medicare glp1 coverage also makes this most opportune.
Biggest barrier I thought was / is the credit card processing. You need to carry a certification for that.
HIPAA not an issue, BAA with most orgs that offer a saas products.
So damn. The glue isn’t really hard. Really didn’t think this would qualify as an ycombinator mvp. But here I am used To pitch decks promising exponential growth of subscription for cloud services.
As for personalized peptides in general, are you going to be marketing non FDA approved ones?
Or just stick with what’s already popular, generic wegovy, zepbound, etc. the market seems highly thin as a new MSO appears everyday using smartiq alongside med spas that offer more questionable inpatient services.
While manufacturing controls supply chain / logistics, the external pressure from every compounding pharmacist scaling into peptides now makes me wonder the longevity abo it this. You can literally pop on subreddits and see the flavor of the month telemedicine practice offer teaser rates of $99 for 60mg/month tirezepatide.
Oh and not forgetting the elephant in the room, gray market and china manufacturing which allows anyone with a telegram account to directly order whatever chemical name they read with no doctor oversight. It’s what, sub $1/mg now from the major vendors for tirezepatide?
by rootsudo