SS-31, also called elamipretide, is the rare research peptide with a finished phase 3 trial — and it came back negative. That inverts every other file on this site. BPC-157, MOTS-c and SLU-PP-332 have no human trial to set the community against. SS-31 has one, a good one, and it missed. It also has a real approval, for one ultra-rare disease. And 117 people in our log use it anyway, at a twentieth of the tested dose, for something else.
This page is a census of behaviour set beside the evidence. It recommends nothing.
The trial that finished
MMPOWER-3 randomised 218 adults with genetically confirmed primary mitochondrial myopathy to elamipretide 40 mg/day by subcutaneous injection or placebo for 24 weeks1. The primary endpoints were the six-minute walk test and a fatigue score.
| Endpoint | Drug minus placebo | 95% CI | p |
|---|---|---|---|
| Six-minute walk distance | −3.2 m | −18.7 to 12.3 | 0.69 |
| PMMSA total fatigue score | −0.07 | −0.10 to 0.26 | 0.37 |
Every secondary endpoint missed as well — patient global impression, clinician global impression, the Neuro-QoL fatigue scale, most bothersome symptom1. Picture a hospital corridor: both groups walk it for six minutes, and the group on the drug stops about one car length short of the placebo group. The confidence interval is a blurry ruler that covers both "helped" and "hurt".
A missed endpoint is not proof a molecule does nothing. It is proof that this trial, at this dose, in this disease, could not show it. Everything else on this page lives in that gap.
The signal inside the miss
Two things in the full text deserve more attention than they get.
First, the phase 3 was run because earlier studies showed a signal: a 36-patient phase 1/2 found a dose-dependent gain on the same walk test2, and the phase 2 "provided an efficacy signal … to support the initiation of this phase 3"1. The phase 3 was the replication, and it failed.
Second, the authors split the patients by genetics afterwards. Those with nuclear-DNA mutations — 27% of the trial — walked 25.2 m further on the drug than on placebo (95% CI 3.1–47.3, p = 0.03; 29 vs 29 people). Those with mitochondrial-DNA mutations walked 11 m *less* (p = 0.21)1. That split was defined after the data came in: shoot the barn wall, then paint the target round the holes. The authors call it post hoc and a question for future trials. We report it exactly that way.
And "well tolerated" has a footnote. Injection-site redness occurred in 86.2% of the drug group against 28.4% on placebo; itching in 75.2% against 9.2%; 7.3% stopped because of side effects against 1.8%. There were no deaths and no drug-related serious adverse events1.
One approval, one disease
Elamipretide is approved — as Forzinity, for Barth syndrome3. Barth syndrome is an X-linked mitochondrial disorder of cardiolipin metabolism with a reported worldwide incidence of 1 in 300,000–400,000 live births2. In the TAZPOWER open-label extension, walking distance, fatigue scores and cardiac volumes held gains through 168 weeks, which supported an accelerated approval to improve muscle strength3.
The label is a key cut for one lock: one disease; one dose — 40 mg subcutaneously once daily for patients weighing 30 kg or more; one patient group. Energy, ageing, recovery and endurance, the uses people discuss, sit outside all three. Approved is true. Approved *for you* is a different sentence.
Where the community data comes from
Our pipeline indexes public discussion. For SS-31 the corpus is YouTube: 1,483 passages — comments under 172 videos and the transcripts of 90. From those it extracted 290 usage records of every provenance, including people describing the trial, animal studies and the label. Keep only records where a human describes their own use, and the log is:
197 reports · 142 sources · 117 people.
A report is one usage claim; a source is one comment or transcript; a person is a person. Every count below uses that filter. The first pack we built did not — it counted 290 reports and 19 people "at the trial dose" — and reading the 19 showed they were quotations. That correction is the subject of the fifth episode, and it is why the filter is stated here before any number.
The hope
Why take a drug that failed its trial? The story in the corpus is mitochondria: 352 of the 1,483 passages say the word, and 789 also name MOTS-c, because SS-31 is pitched as part of a "mitochondrial repair" stack. The pitch — folded inner walls that sag with age or illness and get propped back up — has real roots: the peptide does bind cardiolipin in the inner membrane4, and rats, dogs and mice did better on it in the papers the videos quote. The page usually missing is the human one: 63 of the 90 transcripts never mention a human trial. In people's own words, the reasons they start are a decade of fatigue after Lyme disease, being in their seventies "and in serious need of repair", and life-altering long covid.
Forty milligrams, quoted not taken
Nineteen records mention 40 mg. Read them and they are people quoting the trial — *"the dose that was used that gave these results was 40mg"* — or reading the label aloud. A speed sign states the limit; everyone who passes can read it out; that does not mean anyone is driving it. Filtered to people describing their own use, the number of reports at or above the trial dose is one. Count the quoting as doing, and you publish the opposite of the truth.
A twentieth of the dose
Of the 197 reports, 194 state a dose in milligrams.
| Value | |
|---|---|
| Median | 2 mg |
| Middle half (IQR) | 1 → 5 mg |
| Full range | 0.1 → 50 mg |
| Most common single values | 1 mg (43) · 5 mg (37) · 2 mg (33) |
| Trial dose | 40 mg/day |
The trial tested the compound with a bucket; the community uses a shot glass. The middle of the crowd — 1 to 5 mg — is exactly the range the trial never looked at. That is a description of the gap, not advice in either direction.
The fatigue that cuts three ways
One word wears three hats. The trial measured fatigue as a primary endpoint and found nothing. In the log, when people describe something going wrong, half the time the word is exhaustion or fatigue — 10 of the 20 adverse reports (six mention headache). And two people describe starting SS-31 *because* of chronic fatigue: *"I have severe CFS and responded to 0.100 mg - 0.500mg."* Twenty is a count from a public log, not a rate.
One hundred and forty-three silences
| Stated outcome | Reports |
|---|---|
| None | 143 |
| Positive | 38 |
| Negative | 14 |
| Mixed | 2 |
Ask the classroom "did it work?" and 38 hands go up for yes, 14 for no, and 143 people just sit there. The people who felt nothing do not raise a hand, and they do not write a post either — so a public log counts the wins loudest and the silence not at all. 38 to 14 is a show of hands in a room where most people stayed quiet.
Never past twelve weeks
Fifty-two reports (from 38 people) say how long they ran it. Forty-five are six weeks or less; the median is four weeks; the longest anyone describes is 12 weeks. The trial ran 24. The approval extension ran 168 — fourteen of the community's longest runs laid end to end. It is not only the dose that differs from the evidence. It is the clock.
What a log cannot tell you
Nobody's purchase is verified. No vial was tested. Nothing was weighed. Twenty-three of the 117 people name another compound in the same breath (MOTS-c in 28 reports), so even a clear result could not be pinned on this one. What the log does hold: 117 people, their own words, their own doses — and one finished phase 3 trial that missed.
The whole file in three lines: a real trial finished and came back empty at the full dose; an approval exists, for one rare disease; and a crowd is doing something else at a twentieth of it.
ZyraTrack is a research and education tool. We never sell or source compounds, never recommend doses, and refuse sourcing questions. If you use anything discussed here, that is between you and a clinician; our job is only to make the numbers around it honest.