Recommendations for the conduct of clinical trials for drugs to treat or prevent sarcopenia

Aging Clinical and Experimental Research - Tập 28 - Trang 47-58 - 2015
Jean-Yves Reginster1, Cyrus Cooper2,3, René Rizzoli4, John A. Kanis5, Geoff Appelboom6, Ivan Bautmans7, Heike A. Bischoff-Ferrari8, Maarten Boers9, Maria Luisa Brandi10, Olivier Bruyère1, Antonio Cherubini11, Bruno Flamion12, Roger A. Fielding13, Andrea Ildiko Gasparik14, Luc Van Loon15, Eugene McCloskey5, Bruce H. Mitlak16, Alberto Pilotto17, Suzanne Reiter-Niesert18, Yves Rolland19, Yannis Tsouderos20, Marjolein Visser21,22, Alfonso J. Cruz-Jentoft23
1Department of Public Health, Epidemiology and Health Economics, University of Liege, Liège, Belgium
2MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
3NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
4Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
5Centre for Metabolic Bone Diseases, and Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
6Columbia University Medical Center, The Neurological Institute, New York, USA
7Gerontology and Frailty in Ageing Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
8Department of Geriatrics, University Hospital of Zurich, Zurich, Switzerland
9Department of Epidemiology and Biostatistics; and Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands
10Department of Internal Medicine, University of Florence, Florence, Italy
11Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Ancona, Italy
12Research Unit of Molecular Physiology (URPHYM), NARILIS, University of Namur, Namur, Belgium
13Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, USA
14Department of Public Health and Health Management, University of Medicine and Pharmacy of Tirgu Mures, Tirgu Mures, Romania
15NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, Netherlands
16Lilly Research Laboratories, Eli Lilly and Company Indianapolis USA
17Department of OrthoGeriatrics, Rehabilitation and Stabilization, Frailty Area, E.O. Galliera Hospital, NR-HS, Genoa, Italy
18Bonn,Germany
19Gérontopôle of Toulouse, University of Toulouse III, CHU Purpan, Toulouse, France
20Institut de Recherches Internationales Servier, Suresnes, France
21Department of Health Sciences, VU University, Amsterdam, Netherlands
22Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, Netherlands
23Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, Spain

Tóm tắt

Sarcopenia is an age-related muscle condition which is frequently a precursor of frailty, mobility disability and premature death. It has a high prevalence in older populations and presents a considerable social and economic burden. Potential treatments are under development but, as yet, no guidelines support regulatory studies for new drugs to manage sarcopenia. The objective of this position paper is therefore to suggest a set of potential endpoints and target population definitions to stimulate debate and progress within the medico-scientific and regulatory communities. A multidisciplinary expert working group was hosted by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, which reviewed and discussed the recent literature from a perspective of clinical experience and guideline development. Relevant parallels were drawn from the development of definition of osteoporosis as a disease and clinical assessment of pharmaceutical treatments for that indication. A case-finding decision tree is briefly reviewed with a discussion of recent prevalence estimations of different relevant threshold values. The selection criteria for patients in regulatory studies are discussed according to the aims of the investigation (sarcopenia prevention or treatment) and the stage of project development. The possible endpoints of such studies are reviewed and a plea is made for the establishment of a core outcome set to be used in all clinical trials of sarcopenia. The current lack of guidelines for the assessment of new therapeutic treatments for sarcopenia could potentially hinder the delivery of effective medicines to patients at risk.

Tài liệu tham khảo

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