The erythropoietin-mimetic peptide (EMP) peginesatide belongs to the group of 
erythropoiesis-stimulating agents (ESAs) that are prohibited when misused in 
sports. Peginesatide is a synthetic pegylated homodimer of two cyclic 21-amino 
acid chains. It was approved for the treatment of anaemic patients with chronic 
kidney disease in the USA in 2012, but recalled in 2013 due to prevalent cases 
of acute severe anaphylactoid reactions and associated fatalities (0.02%). The 
drug was considered obsolete for athletes and part of the anti-doping scene lost 
sight of it. However, recent research indicates that the adverse events were not 
caused by the drug substance, but by the drug product formulated in multi-use 
vials. These vials contained comparably high levels of subvisible particles. 
Phenol was identified as a critical component of the drug formulation, which 
caused the release of histamine from mast cells. Tricky athletes might consider 
peginesatide a pharmacologically safe ESA in an appropriate formulation. In 
addition, other EMPs may get a second wind for therapy including misuse in 
sports. Therefore, it is very important to proceed in developing 
electrophoretic, immunological, and mass spectroscopic methods for detecting 
peginesatide and other EMPs in human urine and blood samples. Copyright © 2016 
John Wiley & Sons, Ltd.