ARA-290: uses, evidence and status | Inside Your Peptides

compound file

The answer, first. An 11-amino-acid peptide built from the helix-B face of erythropoietin, engineered to keep the tissue-repair signal and drop the blood-making one. Also called cibinetide. The strongest evidence is for sarcoidosis small-fibre neuropathy symptoms, graded C — small or open-label human only.

In a 22-patient pilot the small-fibre symptom score fell 11.5 points against 2.9 on placebo over 4 weeks ¹.

A 28-day subcutaneous trial found the same direction ². All small, all 4 weeks. The other use — neuropathic pain — grades D or E: a claim the human trials have already tested and not supported.

What it is used for

Every use graded on its own evidence, not the compound as a whole. 4 outcomes, ranked by what the human record supports.

#outcome · human · animal · gradewhat the best evidence actually shows

01Sarcoidosis small-fibre neuropathy symptoms3 trials, n=22 to 64 · rodent neuropathy modelsgrade CIn a 22-patient pilot the small-fibre symptom score fell 11.5 points against 2.9 on placebo over 4 weeks ¹. A 28-day subcutaneous trial found the same direction ². All small, all 4 weeks.

02Corneal and skin nerve fibre regrowthphase 2b, n=64 · supportivegrade CAt 4 mg daily corneal nerve fibre area rose 697 square micrometres above placebo by day 28, in 64 patients ³. The 1 mg and 8 mg arms did not separate. Nerve area is a surrogate.

03Metabolic control and neuropathy in type 2 diabetesphase 2, n=24 · diabetic rodent modelsgrade CTwenty-eight days of 4 mg daily improved HbA1c, lipid profile and PainDetect score against placebo, with the change still present a month after stopping ⁴. Twenty-four patients, never repeated.

04Neuropathic painphase 2b, did not separate · rodent allodynia modelsgrade EPain fell in every arm, placebo included. In patients with moderate to severe pain the 4 mg placebo-corrected difference did not reach significance, p=0.157 ³. Pain has been tested and has not separated.

gradewhat it means

ARegulatory approval, or multiple adequately-powered trials agreeing with each other

BAt least one well-powered human randomised trial, with the direction replicated

CSmall or open-label human trials only

DAnimal or mechanism data only, with no controlled human outcome

EA claim the human trials have already killed

How it works

The proposed mechanism, in three steps. A mechanism is a reason to run a trial, never a substitute for one.

1targetBinds the innate repair receptor, a heterodimer of the erythropoietin receptor and the beta-common receptor, which appears on injured tissue ⁷.

2signalReceptor activation damps innate immune cell recruitment and cytokine output instead of driving erythropoiesis ⁷⁸.

3effectIn humans it raises corneal nerve fibre area and intraepidermal GAP-43-positive fibres, both markers of small nerve regrowth ³.

What it does not do

Claims the current record does not support. Worth knowing before you set expectations.

not supported by the evidence

Treats diabetic macular oedema. Nine patients, 12 weeks, no change in visual acuity or retinal thickness ⁵. A second trial was terminated at 9 enrolled ⁹.
General tissue healing or faster recovery. No human trial has measured tendon, muscle or wound outcomes. The healing evidence is diabetic mice ⁶.
Raises red cells like erythropoietin. It was engineered not to. It signals through the innate repair receptor, not the erythropoietin receptor homodimer ⁷.

How it is used

What published protocols administered, and what the community reports doing. Descriptive on both counts, and never a recommendation.

routeSubcutaneous once daily in most trials. Intravenous three times a week in the first pilot ¹²³.

formatSolution or lyophilised powder for injection.

published dosesTrials dosed 4 mg subcutaneously once daily for 28 days ²³⁴. The phase 2b also ran 1 mg and 8 mg arms and found 4 mg best on the primary endpoint ³. The 2012 pilot gave 2 mg intravenously three times weekly for 4 weeks ¹.

human pharmacokineticsNo human pharmacokinetic data published.

reported conventionsAs reported on peptide forums and vendor protocol sheets, 2018-2026: the trial schedule copied directly, 4 mg subcutaneously daily for roughly four weeks. Lower doses are reported too, for cost. Convention, not guidance.

This site does not publish protocols to follow. The doses above are what studies administered or what users report, stated as facts about the literature and the market. How protocols are structured, mixing and storage and the reconstitution calculator cover the arithmetic.

What to expect

Where a trial measured it, the trial. Where only the community reports it, that is said out loud.

onsetEvery trial read out at 28 days. In the pilot the symptom score had separated from placebo by week 4 ¹. Nothing shorter has been measured, and no published study has dosed anyone for longer than 28 days.

most common reportAs reported: no acute sensation. Where change is described, it is described over weeks, in nerve symptoms.

adverse effectsNo safety concern was raised in any trial. The 64-patient phase 2b and the 24-patient diabetes study reported no drug-related issues, and the eye study detected no anti-cibinetide antibodies ³⁴⁵.

the stop signalTrials ran 28 days and stopped on schedule ²³⁴. No stop rule and no taper appears anywhere in the literature.

Approval and status

What regulators and sport bodies have actually said, separately from what the evidence shows.

approvalNot approved anywhere. Investigational, and stalled at phase 2.

FDANo US approval. Not named on the FDA list of bulk substances flagged for compounding safety risks ¹⁰.

sport [WADA]Not named. Class S2.1.5 covers innate repair receptor agonists ¹¹.

sold asresearch chemical

Check the vial

The grade above describes a molecule studied under controlled conditions. It says nothing about the powder in a particular vial.

That gap is the one part of this market a reader can actually close. How to read a certificate of analysis covers the five measures in five minutes, and the 2026 audit grades vendors on the documents they publish against a rubric printed in full.

Questions we get

What is ARA-290 used for?

In research, small-fibre neuropathy in sarcoidosis, which is the only indication with more than one trial behind it ¹²³.

It has also been tested in type 2 diabetes with painful neuropathy ⁴ and in diabetic macular oedema, where it failed ⁵. In the research market it is bought for nerve pain and nerve repair. It holds no approval anywhere.

How is ARA-290 used?

Descriptively, from published protocols. The phase 2 and phase 2b trials gave 4 mg subcutaneously once daily for 28 days ²³⁴.

The 2012 pilot gave 2 mg intravenously three times weekly for 4 weeks ¹. Every registered trial stopped at 28 days of dosing. No human pharmacokinetic study has been published, so half-life is unknown.

How long does ARA-290 take to work?

Honest answer: nobody knows, because every trial used the same 28-day window. Symptom scores had separated from placebo by week 4 in the pilot ¹. Corneal nerve fibre area had risen by day 28 in the phase 2b ³. No trial measured anything before day 28 or dosed anyone beyond it.

Is ARA-290 an approved drug?

No. ARA-290 is sold as a research chemical, not as an approved medicine. On our index it is graded human trials on clinical evidence and niche on community adoption, and those two are rated separately on purpose.

Its registered trials are all phase 1 or phase 2, the largest enrolled 64 people, and no phase 3 has ever been registered ⁹.

References

Heij L, et al. Safety and efficacy of ARA 290 in sarcoidosis patients with symptoms of small fiber neuropathy: a randomized, double-blind pilot study. Mol Med. 2012. PMID 23168581
Dahan A, et al. ARA 290 improves symptoms in patients with sarcoidosis-associated small nerve fiber loss and increases corneal nerve fiber density. Mol Med. 2013. PMID 24136731
Culver DA, et al. Cibinetide Improves Corneal Nerve Fiber Abundance in Patients With Sarcoidosis-Associated Small Nerve Fiber Loss and Neuropathic Pain. Invest Ophthalmol Vis Sci. 2017. PMID 28475703
Brines M, et al. ARA 290, a nonerythropoietic peptide engineered from erythropoietin, improves metabolic control and neuropathic symptoms in patients with type 2 diabetes. Mol Med. 2015. PMID 25387363
Lois N, et al. A Phase 2 Clinical Trial on the Use of Cibinetide for the Treatment of Diabetic Macular Edema. J Clin Med. 2020. PMID 32674280
Bitto A, et al. Activation of the EPOR-beta common receptor complex by cibinetide ameliorates impaired wound healing in mice with genetic diabetes. Biochim Biophys Acta Mol Basis Dis. 2018. PMID 29223734
Collino M, et al. Flipping the molecular switch for innate protection and repair of tissues: Long-lasting effects of a non-erythropoietic small peptide engineered from erythropoietin. Pharmacol Ther. 2015. PMID 25728128
Nairz M, et al. Cibinetide dampens innate immune cell functions thus ameliorating the course of experimental colitis. Sci Rep. 2017. PMID 29026145
ClinicalTrials.gov. Registered studies of cibinetide and ARA-290. Accessed 24 August 2026. clinicaltrials.gov
US Food and Drug Administration. Certain Bulk Drug Substances for Use in Compounding that May Present Significant Safety Risks. Category 2 lists. fda.gov
World Anti-Doping Agency. The 2026 Prohibited List. In force 1 January 2026. wada-ama.org

Inside Your Peptides is published by the owners of the next lab, a vendor graded elsewhere on this site. We sell nothing here, and this page carries no vendor link. Grades follow the published criteria in our editorial policy — never referral terms. Research and education only. Not medical advice.