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Excretion Pathways Excretion mechanisms for both peptides remain incompletely characterized: Renal filtration likely represents primary elimination route for peptide fragments Hepatic metabolism may contribute to peptide degradation and clearance No evidence of significant biliary excretion in available studies Pharmacokinetic studies in renal or hepatic impairment models are absent from literature The rapid systemic clearance of both peptides contrasts with prolonged downstream effects on growth hormone and IGF-1, indicating that direct peptide presence is not required for sustained biological activity once pituitary signaling cascades are initiated

The treatment-policy estimand is closer to intention-to-treat: it estimates the effect regardless of whether participants stayed on treatment or used rescue therapies