CAS 2003/A/447 Anna Stylianou v/ FINA

On 29 August 2002 the Cyprus Amateur Swimming Association decided to impose a 1 year period of ineligibility on the minor Cypriot swimmer Anna Stylianou (16) after her sample tested positive for the prohibited substance 19-norandrosterone (Nandrolone).

After deliberations the case was referered to the International Swimming Federation (FINA) and 19 February 2003 the FINA Doping Panel decided to impose a 4 year period of ineligibility on the Athlete.

Hereafter the Athlete appealed the FINA decision with the Court of Arbitration for Sport (CAS).

The Athlete admitted the violation, denied the intentional use of the prohibited substance and requested for a reduced sanction. She argued that the Appealed Decision is bases on a misinterpretation of the FINA Doping Rules. Also the Athlete asserted that the FINA decision is neither substantiated nor clear.

The Athlete explained that she had purchased and used three supplements recommended by her coach. She and her doctor had checked the labels of these products before using.

Analysis of two supplements revealed no prohibited substance. Analyisis of the third supplement Inosine was not possible due she had used all capsules. Also the supplement was not available anymore in Cyprus and withdrawn from the market. She asserted that these capsules in question were the source of the positive test.

FINA contended that the had acted with negligence and failed to establish that the supplement Inosine was the source of the positive test. In accordance with the new FINA Doping Control Rules FINA accepted to apply in favor of the Athlete and to reduce the sanction from 4 years to a 2 year period of ineligibility.

The Panel deems that Athlete accepted the test results and that a 2 year period of ineligibility is the appropriate sanction in this case. The Panel finds that FINA failed to show cause as to why the Athlete bears No Significant Fault or Negligence.

The Panel concludes that there are no exceptional circumstances in this case because she acted negligently with her supplements, nor established how the substance had entered her system. The Panel considers that the reduction of the sanction by 2 years is a de jure consequence of the adoption of the Amended WADA Code by FINA. Accordingly the Athlete did not receive the reduction as requested.

Therefore the Court of Arbitration for Sport decides on 30 January 2004 that:

1.) The appeal filed by the Athlete on March 17, 2003 is partially upheld.

2.) The decision of FINA dated February 19, 2003 is hereby amended:

- a) A term of ineligibility of two years is imposed on the Athlete, commencing as of June 16, 2002.
- b) All results achieved by the Athlete during the period from June 16, 2002 until July 2, 2002 shall be deemed cancelled.

3.) This award is rendered without costs, except for the Court Office fee of CHF 500.00 (Five Hundred Swiss Francs) already paid by the Appellant, which shall be retained by the CAS.

4.) Each party shall bear its own respective costs.

Inhaled beta2 agonists and performance in competitive athletes / W. Kindermann, T Meyer. - (British Journal of Sports Medicine 40 (2006) Supplement 1 (July) ; p. 43-47)

• PMID: 16799103
• PMCID: PMC2657501
• DOI: 10.1136/bjsm.2006.027748

Abstract

Objectives: To provide an overview of the current literature on the use of inhaled beta2 agonists in non-asthmatic competitive athletes, and to assess the performance enhancing effect of inhaled beta2 agonists.

Methods: Review of the literature.

Results: Twenty randomised, placebo controlled studies (19 double blind, one single blind) were located. Only three studies reported a performance enhancing effect of inhaled beta2 agonists. However, methodological shortcomings were most likely responsible for these findings (for example, non-elite athletes, inconsistent results in different tests, subgroups with above-average responsiveness).

Conclusions: This review reveals that there is no ergogenic potential of inhaled beta2 agonists in non-asthmatic athletes. In view of the epidemiology of asthma in athletes and the considerable workload involved in provision of therapeutic use exemptions the inclusion of inhaled beta2 agonists on the list of prohibited substances should be reconsidered.

Pharmaceutical treatment of asthma symptoms in elite athletes - doping or therapy? / Vibeke Backer, T. Lund, L. Pedersen. - (Scandinavian Journal of Medicine & Science in Sports 17 (2007) 6 (December) ; p. 615-622).

• PMID: 18093034.
• DOI: 10.1111/j.1600-0838.2007.00711.x

Abstract:

Asthma, exercise‐induced bronchoconstriction, and airway hyper‐responsiveness are often found in elite athletes, perhaps as a consequence of their sport or maybe because asthma is a common disorder in young adults. Inhaled β2‐agonists (IBA) are frequently used in elite athletes, but due to regulations introduced by the International Olympic Committee, the use of anti‐asthmatic therapy might change. Drugs that make ergogenic effect persist are prohibited in all athletes, whether or not they take part in competitions and systemic steroids and β2‐agonists are among such drugs. On the other hand, opinion is more divided about the use of inhaled corticosteroids (ICS) and IBA. In humans, no effect has been found on the oxygen uptake, performance or distance run with therapeutic doses of IBA, either in asthmatics or non‐asthmatics, whereas others report an ergogenic effect and better lung function of high doses of a β2‐agonist in non‐asthmatics. Anti‐asthmatic treatment is necessary for asthmatics, but should not be used by non‐asthmatic elite athletes due to both possible systemic effects and furthermore, side effects of both ICS and IBA.

β₂-Agonists and physical performance : a systematic review and meta-analysis of randomized controlled trials / Babette M. Pluim, Olivier de Hon, J. Bart Staal, Jacqueline Limpens, Harm Kuipers, Shelley E. Overbeek, Aeilko H. Zwinderman, Rob J.P.M. Scholte. - (Sports Medicine 41 (2001) 1 (January) p. 39-57)

• PMID: 21142283
• DOI: 10.2165/11537540-000000000-00000

Abstract:

Inhaled β₂-agonists are commonly used as bronchodilators in the treatment of asthma. Their use in athletes, however, is restricted by anti-doping regulations. Controversies remain as to whether healthy elite athletes who use bronchodilators may gain a competitive advantage.

The aim of this systematic review and meta-analysis is to assess the effects of inhaled and systemic β₂-agonists on physical performance in healthy, non-asthmatic subjects. To this end, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to August 2009. Reference lists were searched for additional relevant studies. The search criteria were for randomized controlled trials examining the effect of inhaled or systemic β₂-agonists on physical performance in healthy, non-asthmatic subjects. Two authors independently performed the selection of studies, data extraction and risk of bias assessment. Parallel-group and crossover trials were analysed separately. Mean difference (MD) and 95% confidence intervals were calculated for continuous data and, where possible, data were pooled using a fixed effects model.

Twenty-six studies involving 403 participants (age range 7-30 years) compared inhaled β₂-agonists with placebo. No significant effect could be detected for inhaled β₂-agonists on maximal oxygen consumption (VO₂(max)) [MD -0.14 mL · kg⁻¹ · min⁻¹; 95% CI -1.07, 0.78; 16 studies], endurance time to exhaustion at 105-110% VO₂(max) (MD -1.5 s; 95% CI -15.6, 12.6; four studies), 20-km time trial duration (MD -4.4 s; 95% CI -23.5, 14.7; two studies), peak power (MD -0.14 W · kg⁻¹; 95% CI -0.54, 0.27; four studies) and total work during a 30-second Wingate test (MD 0.80 J · kg⁻¹; 95% CI -2.44, 4.05; five studies). Thirteen studies involving 172 participants (age range 7-22 years) compared systemic β₂-agonists with placebo, with 12 studies involving oral and one study involving intravenous salbutamol. A significant effect was detected for systemic β₂-agonists on endurance time to exhaustion at 80-85% VO₂(max) (MD 402 s; 95% CI 34, 770; two studies), but not for VO₂(max) (placebo 42.5 ± 1.7 mL · kg⁻¹ · min⁻¹, salbutamol 42.1 ± 2.9 mL · kg⁻¹ · min⁻¹, one study), endurance time to exhaustion at 70% VO₂(max) (MD 400 s; 95% CI -408, 1208; one study) or power output at 90% VO₂(max) (placebo 234.9 ± 16 W, salbutamol 235.5 ± 18.1 W, one study). A significant effect was shown for systemic β₂-agonists on peak power (MD 0.91 W · kg⁻¹; 95% CI 0.25, 1.57; four studies), but not on total work (MD 7.8 J · kg⁻¹; 95% CI -3.3, 18.9; four studies) during a 30-second Wingate test. There were no randomized controlled trials assessing the effects of systemic formoterol, salmeterol or terbutaline on physical performance.

In conclusion, no significant effects were detected for inhaled β₂-agonists on endurance, strength or sprint performance in healthy athletes. There is some evidence indicating that systemic β₂-agonists may have a positive effect on physical performance in healthy subjects, but the evidence base is weak.

Reporting and managing elevated testosterone / epitestosterone ratios--novel aspects after five years' experience / Ute Mareck, Hans Geyer, Gregor Fußhöller, Anne Schwenke, Nadine Haenelt, Thomas Piper, Mario Thevis, Wilhelm Schänzer. - (Drug Testing and Analysis 2 (2010) 11-12 (November) ; p. 637-642)

• PMID: 21204295
• DOI: 10.1002/dta.234

Abstract:

The testosterone/epitestosterone (T/E) ratio was implemented as an indirect parameter for the detection of testosterone administration with an empirically established threshold value at T/E = 6. In 2005, the T/E reporting threshold was lowered from six to four.

Between 2005 and 2009, 63 510 doping control urine samples were analyzed in the Cologne laboratory. A total of 1442 specimens (2.3%) showed a T/E > 4; 80 (5.5%) of which were tested positive by means of isotope ratio mass spectrometry (IRMS); and most of which (68) originated from strength sport disciplines.

Specimens of high T/E ratio showed a much higher probability for being confirmed to contain exogenous testosterone using IRMS analysis than samples of low T/E values.

Considering the small number of adverse analytical findings triggered by lowering the T/E reporting threshold (978 urine specimens with T/E ratios between 4 and 6 yielded only 4 (0.4%) positive IRMS findings) and the known limitations of the T/E ratio as discriminating parameter (UGT2B17 polymorphism), the currently mandatory approach shows only marginal overall efficiency.

A more effective tool for the detection of the misuse of testosterone would be the implementation of individual reference ranges. Until athlete steroidal passports are available, it is suggested to exceed the threshold level for T/E from 4 to 6 and perform obligatory IRMS analysis for specimens showing T/E > 6. Further conditions triggering IRMS analysis could be suppressed luteinizing hormone (LH) values in males and disproportionate changes of relevant parameters in individual profiles evidently not resulting from ethanol consumption.

From population- to subject-based limits of T/E ratio to detect testosterone abuse in elite sports / Pierre-Edouard Sottasa, Christophe Saudana, Carine Schweizer, Norbert Baume, Patrice Mangin, Martial Saugy. - (Forensic Science International 174 (2008) 2-3 ( 30 January) ; p. 166-172)

• PMID: 17485185
• DOI: 10.1016/j.forsciint.2007.04.001

Abstract:

In elite sports, indirect testing of testosterone abuse is mainly based on the testosterone over epitestosterone (T/E) ratio. Since this marker is characterized by a small ratio of intra- to inter-individual variation, it is surprising that current anti-doping strategy uses a screening test based on a population-based limit.

From a database of more than 15,000 steroid profiles obtained from routine controls, the collection of steroids profiles of 11 elite athletes followed during 2 years, and a longitudinal study involving 17 amateur athletes, 8 of which were orally administrated testosterone undecanoate pills, we selected 12 case studies to represent the possible scenarios to which the anti-doping laboratories are confronted.

Various detection strategies at the disposal of the laboratories are employed and discussed, including isotope ratio mass spectrometry (IRMS) analysis and a Bayesian interpretation of the T/E-time profile. The weak sensitivity versus specificity relation of a population-based limit for the T/E ratio is outlined.

As a result, we propose a Bayesian screening test whose T/E threshold progressively evolves from a population basis to a subject basis as the number of individual test results increases. We found that this screening test heightens drastically the capacity to detect testosterone abuse, at no additional financial and administrative expenses for anti-doping authorities.

Performance characteristics of a carbon isotope ratio method for detecting doping with testosterone based on urine diols : controls and athletes with elevated testosterone / epitestosterone ratios / Rodrigo Aguilera, Thomas Edward Chapman, Borislav Starcevic, C.K. Hatton, D.H. Catlin. - (Clinical Chemistry 47 (2001) 2 (February) ; p. 292-300)

• PMID: 11159778

Abstract

Background: Carbon isotope ratio methods are used in doping control to determine whether urinary steroids are endogenous or pharmaceutical.

Methods: Gas chromatography-combustion-isotope ratio mass spectrometry (GC-C-IRMS) was used to determine the delta(13)C values for 5 beta-androstane-3 alpha,17 beta-diyl diacetate (5 beta A), 5 alpha-androstane-3 alpha,17 beta-diyl diacetate (5 alpha A), and 5 beta-pregnane-3 alpha,20 alpha-diyl diacetate (5 beta P) in a control group of 73 healthy males and 6 athletes with testosterone/epitestosterone ratios (T/E) >6.

Results: The within-assay precision SDs for 5 beta A, 5 alpha A, and 5 beta P were +/- 0.27 per thousand, +/- 0.38 per thousand, and +/- 0.28 per thousand, respectively. The between-assay precision SDs ranged from +/- 0.40 per thousand to +/- 0.52 per thousand. The system suitability and batch acceptance scheme is based on SDs. For the control group, the mean delta(13)C (SD) values were -25.69 per thousand (+/- 0.92 per thousand), -26.35 per thousand (+/- 0.68 per thousand), and -24.26 per thousand (+/- 0.70 per thousand), for 5 beta A, 5 alpha A, and 5 beta P, respectively. 5 beta P was greater than 5 beta A and 5 alpha A (P <0.01), and 5 beta A was greater than 5 alpha A (P <0.01). The means - 3 SD were -28.46 per thousand, -28.39 per thousand, and -26.37 per thousand for 5 beta A, 5 alpha A, and 5 beta P, respectively. The maximum difference between 5 beta P and 5 beta A was 3.2 per thousand, and the maximum 5 beta A/5 beta P was 1.13. Three athletes with chronically elevated T/Es had delta(13)C values consistent with testosterone administration and three did not.

Conclusions: This GC-C-IRMS assay of urine diols has low within- and between-assay SDs; therefore, analysis of one urine sample suffices for doping control. The means, SDs, +/-3 SDs, and ranges of delta(13)C values in a control group are established. In comparison, testosterone users have low 5 beta A and 5 alpha A, large differences between 5 beta A or 5 alpha A and 5 beta P, and high 5 beta A/5 beta P and 5 alpha A/5 beta P ratios.

The 2008 Prohibited List International Standard : The World Anti-Doping Code / World Anti-Doping Agency (WADA). - Montreal : WADA, 2007.

- The official text of the Prohibited List shall be maintained by WADA and shall be published in English and French. In the event of any conflict between the English and French versions, the English version shall prevail.
- This List shall come into effect on 1 January 2008

The 2009 Prohibited List International Standard : The World Anti-Doping Code / World Anti-Doping Agency (WADA). - Montreal : WADA, 2008.

- The official text of the Prohibited List shall be maintained by WADA and shall be published in English and French. In the event of any conflict between the English and French versions, the English version shall prevail.
- This List shall come into effect on 1 January 2009

The 2010 Prohibited List International Standard : The World Anti-Doping Code / World Anti-Doping Agency (WADA). - Montreal : WADA, 2009.

- The official text of the Prohibited List shall be maintained by WADA and shall be published in English and French. In the event of any conflict between the English and French versions, the English version shall prevail.
- This List shall come into effect on 1 January 2010