Trevogrumab: Dosing Protocols
Dosing guidelines, reconstitution, and administration information
๐TL;DR
- โข4 dosing protocols documented
- โขReconstitution instructions included
- โขStorage: As a monoclonal antibody, trevogrumab requires refrigerated storage (2-8 degrees C) and protection from light. It must not be frozen. Storage and handling are managed by clinical trial sites per sponsor protocols. The drug is not available for self-administration or home storage outside of clinical trials.
Protocol Quick-Reference
Lean mass preservation during GLP-1 agonist weight loss therapy
Dosing
Amount
200-400 mg
Frequency
Subcutaneous injection (dosing interval not publicly specified)
Duration
26-week weight-loss phase followed by 26-week maintenance
Administration
Route
SCSchedule
Periodic subcutaneous injection (interval not disclosed)
Timing
Administered in combination with semaglutide 2.4 mg SC weekly in the COURAGE trial. Clinical trial setting only.
Cycle
Duration
52 weeks (26-week weight-loss + 26-week maintenance)
Repeatable
Single cycle
โ๏ธ Suggested Bloodwork (4 tests)
DXA body composition scan
When: Baseline and 26 weeks
Why: Measure lean mass and fat mass changes
CMP (Comprehensive Metabolic Panel)
When: Baseline
Why: Liver and kidney function baseline
Lipid panel
When: Baseline and 26 weeks
Why: Monitor cardiovascular risk factors
Anti-drug antibodies
When: Periodic
Why: Monitor for immunogenicity
๐ก Key Considerations
- โInvestigational monoclonal antibody available only through clinical trials; not a peptide and cannot be obtained from peptide suppliers
- โBoth 200 mg and 400 mg doses showed similar lean mass preservation (~51%), suggesting a ceiling effect for myostatin blockade alone
- โTriplet therapy (trevogrumab + garetosmab + semaglutide) had a 28.3% discontinuation rate and two deaths
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| Purpose | Dose | Frequency | Duration | Notes |
|---|---|---|---|---|
| Obesity Combination Therapy (COURAGE Phase 2, Weight-Loss Phase) | Trevogrumab 200 mg or 400 mg SC in combination with semaglutide 2.4 mg SC weekly. At 26 weeks, both doses preserved approximately 50% of lean mass lost with semaglutide alone while increasing fat mass loss. | Subcutaneous injection (dosing interval not publicly specified) | 26-week weight-loss phase followed by 26-week maintenance phase | Both 200 mg and 400 mg doses showed similar lean mass preservation (50.8% vs 51.3%). The higher dose showed modestly greater weight loss and fat loss. Specific dosing interval (Q2W or Q4W) should be confirmed from full trial publication. |
| Obesity Triplet Therapy (COURAGE Phase 2, with Garetosmab) | Trevogrumab 400 mg SC + garetosmab 10 mg/kg IV in combination with semaglutide 2.4 mg SC weekly. At 26 weeks, the triplet preserved 80.9% of lean mass and increased fat loss 27.3% vs semaglutide alone, but had a 28.3% discontinuation rate. | Subcutaneous (trevogrumab) + IV (garetosmab) + SC weekly (semaglutide) | 26-week weight-loss phase | The triplet therapy showed superior lean mass preservation and fat loss but had significantly higher discontinuation rates (28.3% vs 4-10% in other groups) and two deaths. This arm may not advance in its current form. |
| Phase 1 Dose-Finding (Postmenopausal Women) | Single and multiple doses of trevogrumab SC alone or in combination with escalating doses of garetosmab IV. Dose-dependent increases in MRI-quantitated thigh muscle volume observed with combination therapy. | Single dose and multiple-dose regimens tested | Variable duration across two study parts | Phase 1 trial (NCT02943239) in 82 subjects. Specific doses tested not fully disclosed in public reports. Combination blockade showed greater muscle gains than either antibody alone. |
| COURAGE Weight-Maintenance Phase | After the 26-week weight-loss phase, participants are randomized to higher-dose trevogrumab monotherapy or placebo through week 52. This phase evaluates whether trevogrumab alone can maintain body composition improvements without concurrent semaglutide. | Higher-dose trevogrumab SC monotherapy | 26 weeks (weeks 27-52) | Results from the weight-maintenance phase have not been reported. This phase will provide important data on trevogrumab's standalone effects on lean mass and body composition. |
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๐Reconstitution Instructions
Trevogrumab is supplied as a sterile solution for subcutaneous injection in clinical trial settings. The formulation is designed for SC administration and does not require reconstitution by end users. All preparation and administration occurs within clinical trial sites.
๐งStorage Requirements
As a monoclonal antibody, trevogrumab requires refrigerated storage (2-8 degrees C) and protection from light. It must not be frozen. Storage and handling are managed by clinical trial sites per sponsor protocols. The drug is not available for self-administration or home storage outside of clinical trials.
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Before You Begin
Review safety warnings and contraindications before starting any protocol.
Investigational Drug Status#
Trevogrumab is an investigational drug available only within clinical trials. It is not approved by any regulatory agency and cannot be obtained through prescription, pharmacy, or peptide suppliers. All dosing information below is from published clinical trials and conference presentations.
Administration Route#
Trevogrumab is administered as a subcutaneous (SC) injection, distinguishing it from bimagrumab which requires intravenous infusion. SC administration offers practical advantages:
- Potential for self-injection at home
- No requirement for clinical infusion center
- Simpler logistics for chronic dosing
- Better patient compliance for long-term treatment
Clinical Trial Dosing#
COURAGE Trial (Phase 2, Obesity)#
| Parameter | Lower Dose | Higher Dose |
|---|---|---|
| Trevogrumab dose | 200 mg SC | 400 mg SC |
| Semaglutide dose | 2.4 mg SC weekly | 2.4 mg SC weekly |
| Duration | 26-week weight-loss phase | 26-week weight-loss phase |
| n (per arm) | 149 | 152 |
| Lean mass preserved | 50.8% | 51.3% |
| Fat loss increase | +17.8% vs semaglutide | +15.1% vs semaglutide |
COURAGE Triplet Arm#
| Parameter | Value |
|---|---|
| Trevogrumab | 400 mg SC |
| Garetosmab | 10 mg/kg IV |
| Semaglutide | 2.4 mg SC weekly |
| Duration | 26-week weight-loss phase |
| n | 147 |
| Lean mass preserved | 80.9% |
| Fat loss increase | +27.3% vs semaglutide |
Phase 1 Trial (NCT02943239)#
| Parameter | Value |
|---|---|
| Population | Healthy postmenopausal women and males |
| Design | Two-part (single-dose + multiple-dose) |
| Trevogrumab | SC injection (doses not fully disclosed) |
| Garetosmab | IV infusion (escalating doses) |
| Total subjects | 82 |
Dose Comparison Across Studies#
| Context | Dose | Route | Key Finding |
|---|---|---|---|
| COURAGE lower dose | 200 mg | SC | 50.8% lean mass preservation |
| COURAGE higher dose | 400 mg | SC | 51.3% lean mass preservation |
| COURAGE triplet | 400 mg + gareto 10 mg/kg | SC + IV | 80.9% lean mass preservation |
| Phase 1 | Variable | SC | Dose-dependent muscle volume increase |
| Preclinical (mice) | Variable | IP | Muscle hypertrophy and atrophy prevention |
Dosing Considerations#
No Clear Dose-Response for Trevogrumab Alone#
In the COURAGE trial, both the 200 mg and 400 mg trevogrumab doses showed remarkably similar lean mass preservation (50.8% vs 51.3%), suggesting that myostatin blockade alone may have a ceiling effect. This is consistent with the understanding that activin A is a second major negative regulator of muscle mass.
Activin A Blockade Enhances Effect#
Adding garetosmab (anti-activin A) to the trevogrumab + semaglutide combination substantially increased lean mass preservation from ~51% to 80.9%, supporting the concept that both myostatin and activin A must be blocked for maximal muscle preservation.
Not Available for Self-Administration#
Key points about trevogrumab availability:
- Not a peptide: Cannot be synthesized by peptide suppliers
- Monoclonal antibody: Requires mammalian cell production and GMP manufacturing
- Clinical trial only: No approved formulation exists
- Not commercially available: Only accessible through COURAGE trial or future studies
Related Reading#
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Medical Disclaimer
This website is for educational and informational purposes only. The information provided is not intended to diagnose, treat, cure, or prevent any disease. Always consult with a qualified healthcare professional before using any peptide or supplement.