Department of Science and Medicine, WADA, Montreal, Quebec, Canada
Medical Affairs, Exactis Innovation, Montreal, Quebec, Canada.
Br J Sports Med. 2020 Jan;54(1):8-12. doi: 10.1136/bjsports-2018-100196. Epub 2019 Jul 20.
The use of systemic glucocorticoids (GCs), as well as local injections, continues to be a controversial issue in the sport/anti-doping community. There is widespread and legitimate use of GCs for numerous health conditions, yet there are concerns about side effects and the possibility of enhanced athletic performance in limited settings. This is compounded by the uncertainty regarding the prevalence of GC use, mechanisms underlying physiological effects and complex pharmacokinetics of different formulations. While WADA continues to promote research in this complex area, some international sporting federations, major event organisers and professional sports leagues have introduced innovative rules such as needle policies, mandatory rest periods and precompetition guidelines to promote judicious use of GCs, focusing on athlete health and supervision of medical personnel. These complementary sport-specific rules are helping to ensure the appropriate use of GCs in athletes where overuse is a particular concern. Where systemic GCs are medically necessary, Therapeutic Use Exemptions (TUEs) may be granted after careful evaluation by TUE Committees based on specific and strict criteria. Continued vigilance and cooperation between physicians, scientists and anti-doping organisations is essential to ensure that GC use in sport respects not only principles of fairness and adherence to the rules but also promotes athlete health and well-being. The purpose of this narrative review is to summarise the use and management of GCs in sport illustrating several innovative programmes by sport leagues and federations.
在运动/反兴奋剂界，全身使用糖皮质激素（GCs）以及局部注射一直是一个有争议的问题。GCs 在许多健康状况下被广泛且合理地使用，但人们对其副作用以及在有限的情况下提高运动表现的可能性表示担忧。这种情况因 GC 使用的普遍性、生理效应的潜在机制以及不同配方的复杂药代动力学的不确定性而更加复杂。虽然世界反兴奋剂机构（WADA）继续在这一复杂领域推动研究，但一些国际体育联合会、大型赛事组织者和职业体育联盟已经引入了创新规则，如针具政策、强制性休息期和赛前指导方针，以促进 GC 的合理使用，重点关注运动员的健康和医务人员的监督。这些补充性的特定于运动的规则有助于确保在过度使用 GC 成为一个特别关注点的情况下，运动员对 GC 的合理使用。在医学上需要全身使用 GCs 的情况下，可以在 TUE 委员会根据具体和严格的标准进行仔细评估后授予治疗性使用豁免（TUE）。医生、科学家和反兴奋剂组织之间持续保持警惕和合作对于确保运动中 GC 的使用不仅符合公平原则和遵守规则，而且促进运动员的健康和福祉至关重要。本叙述性评论的目的是总结运动中 GCs 的使用和管理情况，并举例说明了一些运动联盟和联合会的创新方案。
