{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T05:13:16Z","timestamp":1788844396194,"version":"build-2803163510"},"posted":{"date-parts":[[2026,9,7]]},"group-title":"Medicine and Pharmacology","reference-count":0,"publisher":"MDPI AG","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,5]]},"abstract":"<jats:p>Body Protection Compound-157 (BPC-157) is an unapproved synthetic peptide marketed directly to consumers despite limited human evidence on benefits and risks. We characterized the use of BPC-157 and patient-reported outcomes from 2020 through 2026 using Large Language Model (LLM) curation of de-identified clinical notes from a U.S. federated network with physician validation of each LLM-curation exercise. Of 1,536 patients with a note mentioning BPC-157, 1,039 (67.6%) had documented use, and quarterly newly confirmed users increased 33-fold between 2020 and 2026. Among 972 BPC-157 users with recorded race, 95.9% were White, compared with 78% of the background care population, representing a 1.23-fold enrichment (chi-square test across racial categories, P &amp;lt; 0.001). Among patients with newly documented BPC-157 use, the male proportion increased from 57% in 2020 to 70% in 2026 (Cochran\u2013Armitage trend test across years, P &amp;lt; 0.001), while mean age decreased from 55 years in 2020 to 49 years in 2026. Among 205 patients with a documented consumer source (19.7% of confirmed users), BPC-157 was most commonly obtained from compounding pharmacies (36%) or gray-market peptide vendors (35%). Other therapeutic agents were co-used with BPC-157 by 525 of 1,039 users (50.5%), most commonly testosterone (17.0%), NSAIDs (14.7%), TB-500 (12.9%), and corticosteroids (11.7%), while physical therapy (15.3%), surgery (12.6%), exercise counseling (8.3%), and diet counseling (6.3%) were the documented non-drug co-interventions. Physician-adjudicated extraction accuracy was 96.0% for BPC-157 co-therapies and 74.4% for non-drug interventions, which were treated as exploratory. Reasons for use were documented for 644 patients and included pain (33% of all 1,039 users), gastrointestinal conditions including reflux, inflammatory bowel disease or gastritis (14%), prior injury (11%), and post-surgical healing (10%), physician adjudicated LLM accuracy of 83.9%. Among 80 users with ascertainable start timing, BPC-157 use preceded first clinician documentation by a mean of 60 days. Reported use averaged 2.2 months among 130 patients (12.5%) with an explicitly documented BPC-157 use duration, with 96.7% extraction accuracy. The specialties most often first documenting use were family medicine, internal medicine, gastroenterology, and orthopaedic surgery. Symptomatic improvement of pain, wound or tissue healing and functional return was documented in 79% of 354 BPC-157 users with a directional response, and symptomatic worsening in 5% of the users (LLM-extraction accuracy 78.4%). Response direction was unavailable for 685 of 1,039 users (65.9%). These reports cannot establish efficacy or distinguish BPC-157 effects from peptide stacking, other co-treatments, non-drug interventions, placebo effects or selection, reporting and confirmation biases. LLM-curated adverse events during BPC-157 use were infrequently noted and likely subject to under-reporting, with documented evidence of neuropsychiatric (1.4%), injection-site hypersensitivity (1.4%), and gastrointestinal (1.3%) events, with physician-adjudicated accuracy of 93.9% for drug-attributed adverse-events. With BPC-157 use rising rapidly despite minimal prospective studies and limited evidence-backed consumer awareness of its risk\u2013benefit profile, this study highlights the need for facilitating structured EHR capture of broader gray-market peptide use and a continuous assessment of guidelines to better support healthcare practitioners.<\/jats:p>","DOI":"10.20944\/preprints202609.0501.v1","type":"posted-content","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T04:23:38Z","timestamp":1788841418000},"source":"Crossref","is-referenced-by-count":0,"title":["Rising Use of Unapproved BPC-157 (\u201cWolverine Peptide\u201d) and Associated Patient-Reported Outcomes Curated from Clinical Notes"],"prefix":"10.20944","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2819-3214","authenticated-orcid":false,"given":"AJ","family":"Venkatakrishnan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adhikaar","family":"Marwaha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Gregg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gowtham","family":"Varma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Hurchik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik","family":"Murugadoss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santhosh","family":"Shivabasappa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venky","family":"Soundararajan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","container-title":[],"original-title":[],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T05:05:53Z","timestamp":1788843953000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.preprints.org\/manuscript\/202609.0501\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":0,"URL":"https:\/\/doi.org\/10.20944\/preprints202609.0501.v1","relation":{},"subject":[],"published":{"date-parts":[[2026,9,7]]},"subtype":"preprint"}}