They are testing for fibrils on the manufactured material in it's post-buffered state in both the patent and in the paper quoted. They even assess it over multiple weeks in the patent. This is not just during the manufacturing process, this is in it's post-buffer, post-constitution state.
There are reasonable arguments about whether or not any of this matters (and indeed, NN is testing a single-chamber pen for cagrisema now), but you are incorrect in this statement.
First of all, I was not talking to you. I was directly responding to a user who claimed that NN had admitted that the current Cagri compound will create fibrils.
That however is not what that hogwash of a facebook post says, it only talks about the chemicals that were tried in the process of developing Cagri.
Now addressing you, you seem to be completely misunderstanding the entire point of the research paper you keep referencing. The research was *not* conducted in such a way as to find out if chemical 23 (Cagrilintide) is dangerous, it is the culmination of all the different research they did before deciding that Cagrilintide is the safest and most effective choice for human use.
That means Novo went and paid probably millions of dollars trying to develop this drug, and they decided that Cagrilintide was the safest and best choice to move forward with for testing, OK? That means after spending all that money, they decided to move foward with this drug for trials, knowing that if they get approved and it later ends up being unsafe they will be paying out the ass in lawsuits.
Now, does that mean we dont have to buffer cagri? I cannot say, but the solubility of 23 (Cagri) is fully soluble and stable all the way up to a PH of 8. Additionally, compound 1 still fibrilated in high dosages despite being in a 4 PH solution, they theorize that is because compound 1 was not soluble at higher PH and after injection the chemical is mixed with the human bodies fluids which are by and large a very constant 7.4-ish PH, no amount of buffering will change this, and you dont want it to because if you did it would fuck you up. It is theorized at low doses compound 1 was kept soluble by albumin, a chemical in human serum fluid, so in higher dosages, as the compound binds and uses up all local albumin, it allows the chemical to fibrilate, and the fibrils do not necessarily redisolve once the albumin returns to the area because the compound is not soluble above PH 5.
What this very clearly shows is that the solubility of the chemical is leaps and bounds more important than the PH of the fluid. YES in storage a ph of 4 is probably better, but when the chemical gets in your blood it is going to be in a 7.4ph solution until it is fully removed from your body.
Cagrilintide (Compound 23) solves this issue by being soluble up to a ph of 8.
It is in my opinion that with the information blatantly available, Cagri is most likely perfectly safe in the short term after reconstitution whether you buffer it to PH 4 or not. As you have said they are already mixing the to in CagriSema.
As far as your concerns about their testing showing that high heat and wear and tear on the chemical can cause fibrils, I would just remind you that these medications are stored in a form that is not reconstituted, and once reconstituted are nowhere near those conditions.