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Possible reasons include the Washington State University patent holders not finding a pharmaceutical company willing to invest in development, the cancer biology concern with c-Met activation making development companies cautious, the preclinical effect sizes in rats not justifying the expense and risk of human trials, or other factors specific to drug development economics

The dose conversion charts available for injectable-to-injectable switches do not apply to oral transitions because bioavailability cannot be assumed

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Growth hormone secretagogues and IGF-1 modulators provide only permissive or marginal anabolic effects, and exercise mimetics may actually suppress anabolic pathways