Pharmacokinetics/pharmacodynamics of recombinant human erythropoietins in doping control

Sports Med. 2003;33(4):301-15. doi: 10.2165/00007256-200333040-00004.

Abstract

The purpose of this paper is: (i) to compare recombinant human erythropoietin (rHuEPO) pharmacokinetics in athletes and healthy individuals; and (ii) to report pharmacokinetic/pharmacodynamic (PK/PD) studies performed in athletes. Effect parameters in PK/PD studies included: (i) red blood cell variables (haematocrit, reticulocyte count); and (ii) markers of iron metabolism (serum soluble transferrin receptors [sTfR], ferritin [fr] and sTfR : fr ratio). To understand the choice of these markers, we first performed a brief review of the pharmacological effects of rHuEPO. Few studies have been conducted in healthy individuals and there are minimal references concerning pharmacokinetics in athletes. A 'flip-flop' phenomenon was noted after subcutaneous administration. The pharmacokinetics appeared linear from 50-1000 U/kg, but this linearity was not observed at the lowest dose of 10 U/kg. A negative-feedback loop of endogenous erythropoietin production occurred at the end of treatment. The half-life of the terminal part of the curves seemed to be slightly higher in athletes (36-42 vs 32 hours) than in untrained individuals and total clearance tended to be greater (17.5 vs 6.5 mL/h/kg). In conclusion, more investigations are needed to better understand the relationship between rHuEPO administration and changes in haematological and iron-metabolism parameters in athletes, particularly after chronic low-dose administration of rHuEPO.

Publication types

  • Review

MeSH terms

  • Doping in Sports* / prevention & control
  • Erythropoiesis
  • Erythropoietin / blood
  • Erythropoietin / pharmacokinetics*
  • Erythropoietin / pharmacology*
  • Half-Life
  • Hematocrit
  • Humans
  • Iron / metabolism
  • Recombinant Proteins
  • Reticulocytes / metabolism
  • Sports / physiology*

Substances

  • Recombinant Proteins
  • Erythropoietin
  • Iron