The systemic effect of glucocorticoids (GCs) following injectable routes of administration presents a potential risk to both improving performance and causing harm to health in athletes. This review evaluates the current GC antidoping regulations defined by the World Anti-Doping Agency and presents a novel approach for defining permitted and prohibited use of glucocorticoids in sport based on the pharmacological potential for performance enhancement (PE) and risk of adverse effects on health. Known performance-enhancing doses of glucocorticoids are expressed in terms of cortisol-equivalent doses and thereby the dose associated with a high potential for PE for any GC and route of administration can be derived. Consequently, revised and substance-specific laboratory reporting values are presented to better distinguish between prohibited and permitted use in sport. In addition, washout periods are presented to enable clinicians to prescribe glucocorticoids safely and to avoid the risk of athletes testing positive for a doping test.
- sports physician
- sports and exercise medicine
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Contributors RV and PD-Y (joint first authors) along with KRC and MS contributed to the scientific research presented. IM, OR contributed to the WADA data presented. FB contributed to the clinical medicine aspects presented. MS contributed to the drug reviews presented and represented the WADA Prohibited List Expert Group. All authors collaborated and formed a consensus on the resulting conclusions and recommendations.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests FB reports grants and personal fees from Horizon Therapeutics, outside the submitted work. PD-Y reports he is a GSK employee and shareholder; GSK is a manufacturer of glucocortiocoid drug products. RV reports that she works at an antidoping laboratory and has worked on research projects funded by WADA. IM and OR are employees of WADA. KRC and MS have nothing to disclose.
Provenance and peer review Not commissioned; externally peer reviewed.