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But now, its more normalised to inject yourself, and people who have never injected are now injecting daily

The peptide may no longer bind to its target receptor

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Esophagitis: Stomach acid repeatedly forced back into the esophagus can cause inflammation and irritation, leading to pain and difficulty swallowing

Specifically regarding product-related impurities or variants, the guidance states that manufacturers should justify for each new specified peptide-related impurity the ANDA applicant should provide justification for why such impurity does not affect the safety of the proposed generic synthetic peptide (including with respect to immunogenicity) and why it does not affect its effectiveness