Farmacja Polska (Mar 2022)
Evaluation of the use of glucocorticosteroids by athletes in Poland in the light of the amended anti-doping regulations
Abstract
Subject of research Glucocorticoids (GCs) have been included in the list of prohibited substances and methods in sport since 2004 by the World Anti-Doping Agency (WADA). In the latest 2022 update of the list in the World Anti-Doping Code all injectable routes of administration of glucocorticoids are prohibited for GCs use in-competition. Before January 1st, 2022, GCs were prohibited in-competition when administered by oral, intravenous, intramuscular or rectal routes, but local injections (in addition to topical applications) were allowed for a local, non-systemic effect. Aim This study therefore aims to evaluate the use of GCs by athletes in Poland, with particular emphasis on the amended regulations. Material and methods Doping control forms (DCFs) from 2130 anti-doping tests carried out in the period from January 1, 2020 to August 31, 2021 were assessed to investigate the list all medications the tested athletes reported on the DCFs for the 7 days prior to controls. The controlled athletes (66% male and 34% female; age 24,7±5,7), with 1321 out-of-competition tests (62%), and 809 tests in-competition (38%). Tests were performed in 36 different disciplines with most in track and field (17.3%), weightlifting (10.0%), canoe / kayak (8.5%), cycling (7.9%), rowing (7.4%), wrestling (6.7%), and aquatics (6.3%) with athletes stratified in progressive aged groups. Statistical analyses were done using the non-parametric Chi-squared test with significance set for p<0.05. Results 7.6% (n = 162) of the surveyed athletes declared the use of GCs in the week preceding doping control. No correlation was observed between GCs use and age of the athletes (p = 0.275 while prevalence of use was the highest in athletes in the 26-30 years age group. Among GCs users, prevalence was not significantly higher in male (8.1%) compared to female athletes (6.7%) (p = 0.237). However, there was a significant sex difference in the used substances (p = 0.008). Among men ciclesonide preparations (40%) were most used while women most frequently used fluticasone (19%).The intake of GCs was significantly depending on sports discipline (p <0.001) with the highest GCs prevalence in shooting, pentathlon, motorcycle racing, rowing, skiing, fencing, and aquatics. Most medications with GCs used by athletes are inhaled drugs (57%) and nasal sprays (26%). Injections (7%), ointments (5%), tablets (3%), eye drops (1%) and medicated shampoos (1%) were also reported. The basic indications for the use of drugs declared by athletes during doping control are bronchial asthma (57% of cases), rhinitis (26%), pain blockade (7%), inflammatory skin diseases (5.5%), Achilles tendinitis (1.5%), Crohn's disease (1.5%), eye infections (1%), and Addison's Disease (0,5%). The time of administration of drugs, i.e. during the competition and out-of-competition periods, also significantly (p = 0.017) influences on the form of medicines taken by athletes. In this study, we did not observe a different prevalence of GCs use between in- and out-of-competition periods (p=0,662) while injections were only reported during out-of-competition controls. Conclusions In conclusion, the frequency of use of GCs was not different during in-competition and out-of-competition periods. It seems that the use of these drugs is not related to pharmacological support in achieving a better result, but is solely due to therapeutic purposes. However, the use of various forms of GCs medicinal preparations are reported with therapeutic purposes. Since substances with different half-lives are prescribed to treat athletes washout periods for such substances shall be carefully accounted for, even though some administration routes are allowed out-of-competition. Guidance on Therapeutic Use Exemptions (TUE) is paramount for athletes and their medical staff to cope with the current WADA regulations and prevent adverse analytical findings for GCs.
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