Recommendations for the conduct of clinical trials for drugs to treat or prevent sarcopenia

Purpose: 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.
Methods: 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.
Results 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 pleais made for the establishment of a core outcome set to be used in all clinical trials of sarcopenia.
Conclusions : 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.