Recommendations for the conduct of clinical trials for drugs to treat or prevent sarcopenia
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
Cruz Jentoft AJ, Michel JP (2013) Sarcopenia: a useful paradigm for physical frailty. Eur Geriatr Med 4:102–105
Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing 39(4):412–423
Muscaritoli M, Anker SD, Argiles J et al (2010) Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by special interest groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr 29(2):154–159
Fielding RA, Vellas B, Evans WJ et al (2011) Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 12(4):249–256
Wakabayashi H, Sakuma K (2014) Comprehensive approach to sarcopenia treatment. Curr Clin Pharmacol 9(2):171–180
Cooper C, Dere W, Evans W et al (2012) Frailty and sarcopenia: definitions and outcome parameters. Osteoporos Int 23(7):1839–1848
Cooper C, Fielding R, Visser M et al (2013) Tools in the assessment of sarcopenia. Calcif Tissue Int 93(3):201–210
Rizzoli R, Reginster JY, Arnal JF et al (2013) Quality of life in sarcopenia and frailty. Calcif Tissue Int 93(2):101–120
Newman AB, Kupelian V, Visser M et al (2006) Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci 61(1):72–77
Delmonico MJ, Harris TB, Visser M et al (2009) Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr 90(6):1579–1585
Koster A, Ding J, Stenholm S et al (2011) Does the amount of fat mass predict age-related loss of lean mass, muscle strength, and muscle quality in older adults? J Gerontol A Biol Sci Med Sci 66(8):888–895
Ferrucci L, Baroni M, Ranchelli A et al (2014) Interaction between bone and muscle in older persons with mobility limitations. Curr Pharm Des 20(19):3178–3197
Morley JE (2012) Sarcopenia in the elderly. Fam Pract 29(Suppl 1):i44–i48. doi:10.1093/fampra/cmr063.:i44-i48
Bijlsma AY, Meskers CG, Westendorp RG et al (2012) Chronology of age-related disease definitions: osteoporosis and sarcopenia. Ageing Res Rev 11(2):320–324
Staron RS, Leonardi MJ, Karapondo DL et al (1991) Strength and skeletal muscle adaptations in heavy-resistance-trained women after detraining and retraining. J Appl Physiol (1985) 70(2):631–640
Frontera WR, Ochala J (2014) Skeletal muscle: a brief review of structure and function. Calcif Tissue Int 96:183–195
Frost M, Nielsen TL, Brixen K et al (2014) Peak muscle mass in young men and sarcopenia in the ageing male. Osteoporos Int 26:749–756
Schaap LA, Pluijm SM, Deeg DJ et al (2008) Low testosterone levels and decline in physical performance and muscle strength in older men: findings from two prospective cohort studies. Clin Endocrinol (Oxf) 68(1):42–50
El Khoudary SR, McClure CK, VoPham T et al (2014) Longitudinal assessment of the menopausal transition, endogenous sex hormones, and perception of physical functioning: the study of women’s health across the nation. J Gerontol A Biol Sci Med Sci 69(8):1011–1017
Frontera WR, Hughes VA, Fielding RA et al (2000) Aging of skeletal muscle: a 12-yr longitudinal study. J Appl Physiol (1985) 88(4):1321–1326
Goodpaster BH, Park SW, Harris TB et al (2006) The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 61(10):1059–1064
Visser M, Goodpaster BH, Kritchevsky SB et al (2005) Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol Sci Med Sci 60(3):324–333
Isidori AM, Strollo F, More M et al (2000) Leptin and aging: correlation with endocrine changes in male and female healthy adult populations of different body weights. J Clin Endocrinol Metab 85(5):1954–1962
Barbat-Artigas S, Pion CH, Leduc-Gaudet JP et al (2014) Exploring the role of muscle mass, obesity, and age in the relationship between muscle quality and physical function. J Am Med Dir Assoc 15(4):303–320
Stenholm S, Harris TB, Rantanen T et al (2008) Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care. 11(6):693–700
Consensus development conference (1993) diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94(6):646–650
Kanis JA, Melton LJ III, Christiansen C et al (1994) The diagnosis of osteoporosis. J Bone Miner Res 9(8):1137–1141
Kanis JA, Johnell O, Oden A et al (2001) Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 12(12):989–995
Kanis JA, Johnell O, Oden A et al (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19(4):385–397
Studenski SA, Peters KW, Alley DE et al (2014) The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci 69(5):547–558
Guralnik JM, Ferrucci L, Pieper CF et al (2000) Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 55(4):M221–M231
Cesari M, Kritchevsky SB, Penninx BW et al (2005) Prognostic value of usual gait speed in well-functioning older people–results from the health, aging and body composition study. J Am Geriatr Soc 53(10):1675–1680
Studenski S, Perera S, Patel K et al (2011) Gait speed and survival in older adults. JAMA 305(1):50–58
Landi F, Cruz-Jentoft AJ, Liperoti R et al (2013) Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing 42(2):203–209
Asher L, Aresu M, Falaschetti E et al (2012) Most older pedestrians are unable to cross the road in time: a cross-sectional study. Age Ageing 41(5):690–694
Beavers KM, Beavers DP, Houston DK et al (2013) Associations between body composition and gait-speed decline: results from the health, aging, and body composition study. Am J Clin Nutr 97(3):552–560
Chen LK, Liu LK, Woo J et al (2014) Sarcopenia in Asia: consensus report of the asian working group for sarcopenia. J Am Med Dir Assoc 15(2):95–101
Zeng P, Wu S, Han Y et al (2015) Differences in body composition and physical functions associated with sarcopenia in Chinese elderly: reference values and prevalence. Arch Gerontol Geriatr 60(1):118–123
Alley DE, Shardell MD, Peters KW et al (2014) Grip strength cutpoints for the identification of clinically relevant weakness. J Gerontol A Biol Sci Med Sci 69(5):559–566
Stenholm S, Alley D, Bandinelli S et al (2009) The effect of obesity combined with low muscle strength on decline in mobility in older persons: results from the InCHIANTI study. Int J Obes (Lond). 33(6):635–644
McLean RR, Shardell MD, Alley DE et al (2014) Criteria for clinically relevant weakness and low lean mass and their longitudinal association with incident mobility impairment and mortality: the foundation for the National Institutes of Health (FNIH) sarcopenia project. J Gerontol A Biol Sci Med Sci 69(5):576–583
Cawthon PM, Peters KW, Shardell MD et al (2014) Cutpoints for low appendicular lean mass that identify older adults with clinically significant weakness. J Gerontol A Biol Sci Med Sci 69(5):567–575
Baumgartner RN, Koehler KM, Gallagher D et al (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147(8):755–763
Dam TT, Peters KW, Fragala M et al (2014) An evidence-based comparison of operational criteria for the presence of sarcopenia. J Gerontol A Biol Sci Med Sci 69(5):584–590
Gallagher D, Visser M, De Meersman RE et al (1997) Appendicular skeletal muscle mass: effects of age, gender, and ethnicity. J Appl Physiol (1985) 83(1):229–239
Visser M, Kritchevsky SB, Goodpaster BH et al (2002) Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study. J Am Geriatr Soc 50(5):897–904
Scott D, Hayes A, Sanders KM et al (2014) Operational definitions of sarcopenia and their associations with 5-year changes in falls risk in community-dwelling middle-aged and older adults. Osteoporos Int 25(1):187–193
Beaudart C, Reginster JY, Slomian J et al (2014) Estimation of sarcopenia prevalence using various assessment tools. Exp Gerontol 61:31–37
Bischoff-Ferrari HA, Orav JE, Kanis JA et al (2015) Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community-dwelling seniors age 65 and older. Osteoporos Int 26:2793–2802
Chumlea WC, Cesari M, Evans WJ et al (2011) Sarcopenia: designing phase IIB trials. J Nutr Health Aging 15(6):450–455
Cesari M, Fielding RA, Pahor M et al (2012) Biomarkers of sarcopenia in clinical trials-recommendations from the international working group on sarcopenia. J Cachexia Sarcopenia Muscle 3(3):181–190
Vellas B, Pahor M, Manini T et al (2013) Designing pharmaceutical trials for sarcopenia in frail older adults: EU/US Task Force recommendations. J Nutr Health Aging 17(7):612–618
Pahor M, Guralnik JM, Ambrosius WT et al (2014) Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA 311(23):2387–2396
Papanicolaou DA, Ather SN, Zhu H et al (2013) A phase IIA randomized, placebo-controlled clinical trial to study the efficacy and safety of the selective androgen receptor modulator (SARM), MK-0773 in female participants with sarcopenia. J Nutr Health Aging 17(6):533–543
Cherubini A, Del-Signore S, Ouslander J et al (2010) Fighting against age discrimination in clinical trials. J Am Geriatr Soc 58(9):1791–1796
Beasley JM, Shikany JM, Thomson CA (2013) The role of dietary protein intake in the prevention of sarcopenia of aging. Nutr Clin Pract 28(6):684–690
Mithal A, Bonjour JP, Boonen S et al (2013) Impact of nutrition on muscle mass, strength, and performance in older adults. Osteoporos Int 24(5):1555–1566
Guralnik JM, Simonsick EM, Ferrucci L et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49(2):M85–M94
Savva GM, Donoghue OA, Horgan F et al (2013) Using timed up-and-go to identify frail members of the older population. J Gerontol A Biol Sci Med Sci 68(4):441–446
Cerreta F, Eichler HG, Rasi G (2012) Drug policy for an aging population—the European medicines agency’s geriatric medicines strategy. N Engl J Med 367(21):1972–1974
Fielding RA, Rejeski WJ, Blair S et al (2011) The lifestyle interventions and independence for elders study: design and methods. J Gerontol A Biol Sci Med Sci 66(11):1226–1237
Rolland YM, Cesari M, Miller ME et al (2004) Reliability of the 400-m usual-pace walk test as an assessment of mobility limitation in older adults. J Am Geriatr Soc 52(6):972–976
Lebrasseur NK, Bhasin S, Miciek R et al (2008) Tests of muscle strength and physical function: reliability and discrimination of performance in younger and older men and older men with mobility limitations. J Am Geriatr Soc 56(11):2118–2123
Barbat-Artigas S, Rolland Y, Cesari M et al (2013) Clinical relevance of different muscle strength indexes and functional impairment in women aged 75 years and older. J Gerontol A Biol Sci Med Sci 68(7):811–819
Hicks GE, Shardell M, Alley DE et al (2012) Absolute strength and loss of strength as predictors of mobility decline in older adults: the InCHIANTI study. J Gerontol A Biol Sci Med Sci 67(1):66–73
Bautmans I, Njemini R, Predom H et al (2008) Muscle endurance in elderly nursing home residents is related to fatigue perception, mobility, and circulating tumor necrosis factor-alpha, interleukin-6, and heat shock protein 70. J Am Geriatr Soc 56(3):389–396
Vestergaard S, Nayfield SG, Patel KV et al (2009) Fatigue in a representative population of older persons and its association with functional impairment, functional limitation, and disability. J Gerontol A Biol Sci Med Sci 64(1):76–82
Kent-Braun JA, Callahan DM, Fay JL et al (2014) Muscle weakness, fatigue, and torque variability: effects of age and mobility status. Muscle Nerve 49(2):209–217
Appelboom G, Camacho E, Abraham ME et al (2014) Smart wearable body sensors for patient self-assessment and monitoring. Arch Public Health. 72(1):28–72
Buckinx F, Beaudart C, Slomian J et al (2014) Added value of a triaxial accelerometer assessing gait parameters to predict falls and mortality among nursing home residents: a two-year prospective study. Technol Health Care 23:195–203
Puts MT, Shekary N, Widdershoven G et al (2007) What does quality of life mean to older frail and non-frail community-dwelling adults in the Netherlands? Qual Life Res 16(2):263–277
Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483
Sayer AA, Syddall HE, Martin HJ et al (2006) Is grip strength associated with health-related quality of life? Findings from the Hertfordshire cohort study. Age Ageing 35(4):409–415
Beaudart C, Reginster JY, Petermans J et al (2015) Quality of life and physical components linked to sarcopenia: the SarcoPhAge study. Exp Gerontol 69:103–110
EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208
Felson DT, Anderson JJ, Boers M et al (1993) The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The committee on outcome measures in rheumatoid arthritis clinical trials. Arthritis Rheum 36(6):729–740
Kirkham JJ, Boers M, Tugwell P et al (2013) Outcome measures in rheumatoid arthritis randomised trials over the last 50 years. Trials 14:324
Core Outcome Measures in Effectiveness Trials (COMET). http://www.comet-initiative.org/. Accessed 21 Nov 2014
Boers M, Idzerda L, Kirwan JR et al (2014) Toward a generalized framework of core measurement areas in clinical trials: a position paper for OMERACT 11. J Rheumatol 41(5):978–985
Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156
Lawton MP (1971) The functional assessment of elderly people. J Am Geriatr Soc 19(6):465–481
European Innovation Partnership on Active and Healthy Ageing. A Europe 2020 Initiative. http://ec.europa.eu/research/innovation-union/index_en.cfm?section=active-healthy-ageing. Accessed 21 Nov 2014
AginginMotion.org. http://aginginmotion.org/. Accessed 19 Nov 2014
Beaudart C, Rizzoli R, Bruyere O et al (2014) Sarcopenia: burden and challenges for public health. Arch Public Health 72(1):45
Janssen I, Shepard DS, Katzmarzyk PT et al (2004) The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc 52(1):80–85
Fairhall N, Sherrington C, Lord SR et al (2014) Effect of a multifactorial, interdisciplinary intervention on risk factors for falls and fall rate in frail older people: a randomised controlled trial. Age Ageing 43(5):616–622
Romero-Ortuno R, O’Shea D (2013) Fitness and frailty: opposite ends of a challenging continuum! Will the end of age discrimination make frailty assessments an imperative? Age Ageing 42(3):279–280
Kanis JA, McCloskey EV, Johansson H et al (2013) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24(1):23–57