Erythropoietin doping in cycling: lack of evidence for efficacy and a negative risk-benefit / J.A. Heuberger, J.M. Cohen Tervaert, F.M. Schepers, A.D. Vliegenthart, J.I. Rotmans, J.M. Daniels, J. Burggraaf, A.F. Cohen. – (British journal of clinical pharmacology (2013) 6 (June) : p. 1406-1421) doi: 10.1111/bcp.12034.
Comment in:
Little soldiers in their cardboard cells / E. van Breda, J. Benders, H. Kuipers. - (British journal of clinical pharmacology (2014) 3 (March) : p. 580-581) doi: 10.1111/bcp.12187.
World-class cyclists on erythropoietin / J.A. Heuberger, A.F. Cohen. - (British journal of clinical pharmacology (2014) 3 (March) : p. 582) doi: 10.1111/bcp.12186.
Content:
- Sport is big business
- Physiology of erythropoietin
• Production and metabolism
• Recombinant erythropoietin in disease
• …and in sport. But does it work?
- Wat is endurance performance?
• Main determining performance?
• VO²max is aprerequisite but not a sole determining factor
• It is more than the VO²max
• Lactate Thresholt (LT)
• Lactate Turn Point (LTP)
• Economy (C)
• Other factors
- Studying the effects of rHuEPO on endurance performace
• Search strategy
• Study population mismatch with professional cyclists
• RHueEPO dosing
• Haematological effects of rHuEPO
• Effects on VO²max
• Does it translate to cycling performance?
• Other endurance performance parameters unstudied
• Alternative mechanism by which EPO works?
• Lack of scientific evidence
• A more scientific approach needed
- rHuEPO adverse effects in athletes
- Cyclists and rHuEPO: a risky choice to what advantage?
Imagine a medicine that is expected to have very limited effects based upon knowledge of its pharmacology and (patho)physiology and that is studied in the wrong population, with low-quality studies that use a surrogate end-point that relates to the clinical end-point in a partial manner at most. Such a medicine would surely not be recommended. The use of recombinant human erythropoietin (rHuEPO) to enhance performance in cycling is very common. A qualitative systematic review of the available literature was performed to examine the evidence for the ergogenic properties of this drug, which is normally used to treat anaemia in chronic renal failure patients. The results of this literature search show that there is no scientific basis from which to conclude that rHuEPO has performance-enhancing properties in elite cyclists. The reported studies have many shortcomings regarding translation of the results to professional cycling endurance performance. Additionally, the possibly harmful side-effects have not been adequately researched for this population but appear to be worrying, at least. The use of rHuEPO in cycling is rife but scientifically unsupported by evidence, and its use in sports is medical malpractice. What its use would have been, if the involved team physicians had been trained in clinical pharmacology and had investigated this properly, remains a matter of speculation. A single well-controlled trial in athletes in real-life circumstances would give a better indication of the real advantages and risk factors of rHuEPO use, but it would be an oversimplification to suggest that this would eradicate its use.
