Anamorelin vs Ghrelin

Ghrelin is the endogenous acyl-peptide hormone that activates GHS-R1a to drive hunger and GH release. Anamorelin is a synthetic, orally active mimic designed to reproduce those effects with a usable half-life.

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Anamorelin

An orally active, non-peptide ghrelin-receptor agonist approved in Japan for cancer cachexia — the best-trialled molecule in the secretagogue class.

BEST STUDIED FOR

GH secretagogues

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Ghrelin

The endogenous 28-amino-acid stomach hormone that activates the growth-hormone secretagogue receptor — the natural ligand every synthetic secretagogue imitates.

BEST STUDIED FOR

GH secretagogues

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SIDE BY SIDE

	Anamorelin	Ghrelin
The key difference	Synthetic oral mimetic	The native acylated stomach hormone
Class	GH secretagogues	GH secretagogues
Mechanism	Anamorelin binds GHS-R1a, increasing appetite signalling and GH/IGF-1 release, studied as a way to counter the muscle and weight loss of cancer anorexia-cachexia.	Discovered in 1999 as the natural ligand of GHS-R1a, acylated ghrelin stimulates pituitary GH release and is a powerful orexigenic (appetite) signal.
Status	Approved in Japan (2021) for cancer cachexia in several tumour types; two phase 3 trials (ROMANA 1 and 2) are the core dataset.	Endogenous hormone and research tool; synthetic ghrelin-receptor agonists (anamorelin, macimorelin) have reached approval in specific indications elsewhere.
Reported safety signals	The phase 3 programme reported it was generally well tolerated; hyperglycaemia and other events were monitored. Meta-analyses summarise effects on body weight and lean mass.	As a research reagent it is a physiological hormone; increased appetite and GH/cortisol release are expected pharmacology.
A key study	Two phase 3 trials measured anamorelin’s effect on lean body mass and other cachexia outcomes in advanced NSCLC. (Lancet Oncol 2016, PMID 26906526)	The discovery paper identifying ghrelin as the endogenous, acylated ligand of the GH secretagogue receptor. (Nature 1999, PMID 10604470)

WHEN TO RESEARCH WHICH

Native ghrelin suits physiology studies; anamorelin suits studies that need an orally dosed, stable ghrelin-receptor agonist. Both are discussed here strictly as research compounds; nothing on this page is medical advice or a dosing guide.

REFERENCES (PUBMED)

[Anamorelin] Anamorelin in patients with non-small-cell lung cancer and cachexia (ROMANA 1 and ROMANA 2): results from two randomised, double-blind, phase 3 trials — Lancet Oncol 2016. PMID 26906526
[Anamorelin] Anamorelin for cancer anorexia-cachexia syndrome: a systematic review and meta-analysis — Support Care Cancer 2017. PMID 28074289
[Anamorelin] Anamorelin in Japanese patients with cancer cachexia: an update — Curr Opin Support Palliat Care 2023. PMID 37389636
[Ghrelin] Ghrelin is a growth-hormone-releasing acylated peptide from stomach — Nature 1999. PMID 10604470
[Ghrelin] Ghrelin — Mol Metab 2015. PMID 26042199
[Ghrelin] Ghrelin and Neurodegenerative Disorders-a Review — Mol Neurobiol 2017. PMID 26809582

FREQUENTLY ASKED

What is the difference between Anamorelin and Ghrelin?

What is the regulatory status of Anamorelin and Ghrelin?

Anamorelin: Approved in Japan (2021) for cancer cachexia in several tumour types; two phase 3 trials (ROMANA 1 and 2) are the core dataset. Ghrelin: Endogenous hormone and research tool; synthetic ghrelin-receptor agonists (anamorelin, macimorelin) have reached approval in specific indications elsewhere.

What safety signals have been reported?

Anamorelin: The phase 3 programme reported it was generally well tolerated; hyperglycaemia and other events were monitored. Meta-analyses summarise effects on body weight and lean mass. Ghrelin: As a research reagent it is a physiological hormone; increased appetite and GH/cortisol release are expected pharmacology.

Which studies is this comparison based on?

For Anamorelin: “Anamorelin in patients with non-small-cell lung cancer and cachexia (ROMANA 1 and ROMANA 2): results from two randomised, double-blind, phase 3 trials” (PMID 26906526); “Anamorelin for cancer anorexia-cachexia syndrome: a systematic review and meta-analysis” (PMID 28074289); “Anamorelin in Japanese patients with cancer cachexia: an update” (PMID 37389636). For Ghrelin: “Ghrelin is a growth-hormone-releasing acylated peptide from stomach” (PMID 10604470); “Ghrelin” (PMID 26042199); “Ghrelin and Neurodegenerative Disorders-a Review” (PMID 26809582).