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This supports the potential of compounded cyanocobalamin/SNAC as a practical alternative for patients who are injection/needle-averse , non-compliant with injections, or seeking a more convenient therapy even if their providers have traditionally used methylcobalamin in injectable form

70 For example, compound 2j, a triazole-containing derivative, has demonstrated high potency and comparable efficacy to danuglipron in preclinical studies, suggesting it could serve as a lead compound for further development

The current evidence base is heavily skewed towards preclinical studies, and while these provide a strong foundation, they cannot definitively predict human outcomes

They fail because the handling protocol ignored the basic thermodynamics of protein folding