Audit refresh — 21 new entries, 7 rerated, 8 minor
First full evidence audit since launch. Worked category by category against PubMed, ClinicalTrials.gov, AdisInsight, and bioRxiv. Net result: the database grew from 357 to 377 interventions across 19 categories, and 31 malformed CSV rows (silent unescaped commas) were repaired.
Score-relevant rerates:
- Rapamycin — downgraded. The PEARL trial (April 2025) missed its primary endpoint of visceral adiposity reduction. Secondary signals on lean mass and well-being held up; the headline longevity claim did not.
- Multi-cancer early detection (Galleri) — downgraded from Moderate to Weak–Moderate. NHS-Galleri 2026 — the first large RCT of MCED — did not reduce late-stage cancer incidence.
- Cagrilintide (CagriSema) — re-framed. REDEFINE 1/2 (NEJM, June 2025) came in below Phase 2 expectations (-20.4% vs ~25% projected) and below tirzepatide 15 mg's SURMOUNT-1 number. Removed the prior "rivals tirzepatide" framing.
- Tirzepatide — refined with SURMOUNT-5 head-to-head vs semaglutide (-20.2% vs -13.7%) and SURMOUNT-1 176-week extension data.
- Testosterone (TRT) — FDA Feb 2025 label change folded in. Boxed cardiovascular warning removed; class-wide blood pressure warning added; AF / AKI / PE signals from TRAVERSE acknowledged.
- Niacin — Lp(a) niche eclipsed by RNA-targeted agents (olpasiran, pelacarsen, lepodisiran et al). Notes refreshed.
- Retatrutide — TRIUMPH Phase 3 program detail (4 trials + TRANSCEND-CKD + TRIUMPH-Outcomes CVOT) updated.
New entries — Weight loss: orforglipron (Lilly oral small-molecule GLP-1), survodutide (BI/Zealand GLP-1/glucagon), maridebart cafraglutide / MariTide (Amgen monthly peptide-antibody), mazdutide (Innovent dual agonist, approved China 2025).
New entries — CV/Lipid: Lp(a)-lowering therapies (olpasiran / pelacarsen / lepodisiran / zerlasiran / muvalaplin) as a class entry; obicetrapib (next-gen CETP inhibitor).
New entries — Hormones: fezolinetant (Veozah, NK3 antagonist for VMS); elinzanetant (Lynkuet, dual NK1/NK3 antagonist); resmetirom (Rezdiffra, first FDA-approved MASH/NASH drug); romosozumab (Evenity, sclerostin antibody for osteoporosis).
New entries — Mental Health: dextromethorphan-bupropion (Auvelity, oral rapid-acting antidepressant); zuranolone (Zurzuvae, oral PPD); xanomeline-trospium (Cobenfy / KarXT, first new schizophrenia mechanism in 50+ years).
New entries — Cognitive: anti-amyloid mAbs (lecanemab / donanemab / aducanumab) as a class entry, with the 2026 Cochrane meta-analysis showing only trivial cognitive benefit; solriamfetol (Sunosi); pitolisant (Wakix); phenibut (with explicit dependence/withdrawal warning).
New entries — Recovery: suzetrigine (Journavx, first new acute pain mechanism in decades); glucosamine + chondroitin.
New entries — Longevity: pyrroloquinoline quinone (PQQ).
New entries — Immune: bovine lactoferrin.
Minor refreshes: bimagrumab, enclomiphene/clomiphene, estradiol HRT (NK3/NK1 cross-ref), TMS (SAINT clearance), microplastics (2026 Polimeni cardiovascular review).
Full per-row entries with DOIs and PMIDs live in the repo at
src/data/audit_log.md. Eight cross-category duplicates
(tesofensine, ashwagandha, collagen peptides, quercetin, berberine,
astaxanthin, CoQ10, microdose lithium) are flagged for consolidation
in a future pass.