ARA-290 dosage and evidence

What is ARA-290?

How does ARA-290 work?

It switches on the innate repair receptor, which drives tissue protection and nerve repair. It does this without making more red blood cells.

What have studies in people found about ARA-290?

ARA-290, also called cibinetide, has been through a handful of small trials with a dummy treatment, from 9 to 64 people each. The company that owns it ran or co-wrote all of them. The steady result is a change in nerve fibres seen on scans of the eye's surface. Results on symptoms and daily function are mixed. The trial built to test pain against a dummy could not tell the two apart.

• The biggest trial, 64 patients (already cited): 4 mg a day clearly increased the nerve fibre area seen in the eye, compared with a dummy shot. But pain improved in every group, so the drug's effect on pain could not be separated from the dummy. This is the most useful single result on file, and it is the negative half.
• Sarcoidosis nerve damage: 22 patients with sarcoidosis, an inflammatory disease, and damage to their small nerves (already cited on this page). Four weeks of ARA 290 into a vein improved their nerve symptom score and their pain and physical function scores, compared with a dummy.
• The same kind of patients took daily shots for 28 days (already cited). Nerve symptoms improved and small nerve fibres in the eye increased, compared with a dummy shot.
• Type 2 diabetes: people injected 4 mg a day for 28 days and were watched for another month. The authors report better three-month average blood sugar and blood fats over the 56 days, and less nerve pain on a questionnaire. Nerve fibres in the eye increased only in people who started well below normal. No safety problems were found. The published summary does not say how many people took part.
• Diabetic swelling at the back of the eye: 9 people started and 8 finished 12 weeks of 4 mg a day. Vision did not improve; it was 2.9 letters worse on average. Retinal thickness, retinal sensitivity and tear production did not improve either. Only a questionnaire about how people rated their own vision rose, by 2.7 points. There were no serious side effects and no antibodies against the drug. Four authors are officers and shareholders of the owner, Araim Pharmaceuticals.
• A second try at that eye use (NCT06626971) was stopped after 9 people.
• A 36-person study in Leiden of ARA290 and how healthy volunteers think and process emotions finished in February 2014. No results have been posted.

What this does not tell you: No large final-stage trial exists for any use. The biggest trial had 64 people and the longest ran 12 weeks. Nerve fibre counts in the eye are scan measures. They show nerve structure in the eye, not symptoms, daily function or whether a disease is getting worse. Every trial took people with sarcoidosis or diabetes. So nothing here speaks to the general nerve repair and anti-inflammation uses it is sold for. And the company's officers are authors on the trials. That is disclosed and normal for a company this size, but it means no independent group has repeated any finding.

What do people who took ARA-290 report?

This is what real people say happened to them, good and bad. Nobody measured it. A report cannot tell a real effect from the lift people get just from expecting it to work, from a diet or training change made at the same time, or from what was really in the vial. We still put it near the top. It is the next best thing to a study in people: what happens when real people use it, including what goes wrong.

• Discussed almost entirely for nerve symptoms, particularly nerve damage from diabetes and recovery after spinal surgery, which is unusual for these communities and keeps the threads small.
• The dose described is around 4 mg as a daily shot under the skin, taken from published trial plans rather than from any prescribing information. The most common question in the threads, how long to run it and whether to repeat, is also the one that most often goes unanswered.
• The timeline described is slow. An extended initial period with nothing noticeable, followed by tingling that posters read as nerves becoming active again, is the pattern reported most often, while others describe changes in sensitivity within a couple of weeks.
• Because tingling is both the reported sign of progress and a symptom of the condition being treated, nothing in these self-reports separates the two, and the threads do not attempt to.
• There is very little of this discussion in total. That protocol questions routinely go unanswered is itself the clearest finding here: no settled practice exists around it.

Sources: A MESO-Rx experience thread read through site-restricted search results because that board does not serve automated fetches from this environment, plus an ExcelMale thread in which questions about how to run it went unanswered, September 2026. Nothing above is attributed to any specific post and no post is reproduced.

The state of the research

The evidence, in charts

The studies we cite

• Study in people2012
  Safety and efficacy of ARA 290 in sarcoidosis patients with symptoms of small fiber neuropathy: a randomized, double-blind pilot study

  A first small trial suggested ARA 290 eases nerve pain in sarcoidosis. Twenty-two patients took it into a vein, or a dummy, for four weeks. The people on the drug reported fewer nerve symptoms, less pain and better physical functioning. Nothing worrying turned up on safety. Twenty-two people over four weeks is a pilot study, not an answer. Everything measured here was what patients reported about themselves, which is the measure most easily moved by expectation.

  22 patients, 4 weeks of IV ARA 290 versus placebo: significant improvement in small-fiber neuropathy symptom score and SF-36 pain and physical functioning, no safety signals.

  PMID 23168581 Molecular Medicine
• Study in people2013
  ARA 290 improves symptoms in patients with sarcoidosis-associated small nerve fiber loss and increases corneal nerve fiber density

  A month of daily shots improved nerve symptoms and, for once, changed something a machine could see. Patients with sarcoidosis and nerve fibre loss injected ARA 290 or a dummy under the skin for 28 days, and nobody involved knew which. Symptoms improved, and the density of tiny nerve fibres in the cornea went up. That second measure matters because it does not depend on how anyone feels. This was still a short study in a small group with one uncommon disease.

  28 days of daily subcutaneous ARA 290 improved neuropathic symptoms and increased corneal small nerve fiber density in a blinded placebo-controlled trial.

  PMID 24136731 Molecular Medicine
• Study in people2017
  Cibinetide improves corneal nerve fiber abundance in patients with sarcoidosis-associated small nerve fiber loss and neuropathic pain

  The larger trial showed a change in the nerves and failed to show a change in the pain. Sixty-four patients with sarcoidosis took 4 mg a day or a dummy injection. The area of tiny nerve fibres in the cornea grew on the drug. But pain got better in every group, including the dummy one, so there is no way to tell the drug apart from expectation on the thing patients actually care about. That is the result, and it is a disappointment.

  Phase 2b in 64 patients: 4 mg/day cibinetide significantly increased corneal nerve fiber area versus placebo; pain improved in all groups, so the pain effect was not clearly separated from placebo.

  PMID 28475703 Investigative Ophthalmology and Visual Science
• Study in people2015
  ARA 290, a nonerythropoietic peptide engineered from erythropoietin, improves metabolic control and neuropathic symptoms in patients with type 2 diabetes

  People with diabetes and painful nerve damage injected ARA-290 daily for a month, and several measures moved. Average blood sugar and blood fats improved over two months of watching, and people reported less nerve pain. Nerve fibres in the eye increased only in those who started well below normal. The published summary never says how many people took part, which makes the result impossible to weigh. Nobody has repeated it.

  28 days of 4 mg per day self-administered subcutaneously in type 2 diabetes with painful neuropathy: improved HbA1c and lipids over 56 days of observation and improved PainDetect scores. Corneal nerve fiber density rose only in subjects starting more than 1 SD below normal. The abstract does not state the number randomized.

  PMID 25387363 Molecular Medicine
• Study in people2020
  A Phase 2 Clinical Trial on the Use of Cibinetide for the Treatment of Diabetic Macular Edema

  Every objective measure in this small trial stayed flat. Nine people with swelling at the centre of the retina injected cibinetide daily for three months, and eight finished. Their vision did not improve. Neither did retinal thickness, retinal sensitivity or tear production. The only thing that rose was how they rated their own sight on a questionnaire. Four of the authors are officers and shareholders in the company that owns the drug. Nine people cannot settle the question either way.

  9 patients recruited and 8 completed 12 weeks at 4 mg per day: no improvement in visual acuity, central retinal thickness, retinal sensitivity or tear production. Only the vision-related quality of life composite moved. Four authors are officers and shareholders of the sponsor.

  PMID 32674280 Journal of Clinical Medicine
• Study in people2014
  Cognitive and Neural Effects of ARA290

  A university study of ARA-290 and the emotions finished twelve years ago and has published nothing. Thirty six healthy volunteers took part at a Dutch medical centre, in work looking at how the peptide affected thinking and the brain's handling of emotion. The trial completed in February 2014 and no results have ever been posted. A completed trial that reports nothing is itself a finding, and it leaves this question blank rather than answered.

  36 healthy volunteers in a Phase 1/2 study of ARA290 and the cognitive and neural processing of emotions, completed February 2014. No results have been posted.

  NCT02070783 ClinicalTrials.gov, Leiden University Medical Center
• Animal study2008
  Nonerythropoietic, tissue-protective peptides derived from the tertiary structure of erythropoietin

  In animals with stroke, kidney and nerve injuries, an 11 amino acid peptide copying part of EPO protected tissue. In a dish and in animals, it did not make more red blood cells.

  An 11-amino-acid peptide mimicking the aqueous face of EPO helix B was tissue-protective in stroke, renal and nerve-injury models and was not erythropoietic in vitro or in vivo.

  PMID 18676614 Proceedings of the National Academy of Sciences