DACORSIN/4: Study of the Excretion of Orally Administered Corticosteroids for the Improval of the Detection of Said Substances in Anti-doping Controls

Sponsor

Parc de Salut Mar (Other)

Overall Status

Recruiting

CT.gov ID

NCT04791345

Collaborator

(none)

Enrollment

Location

Arms

Anticipated Duration (Months)

4.2

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Background:

Glucocorticoids (GC) were included in the list of banned substances in sports in 1986, because of evidences of positive effects on physical performance and the important health risks associated with its consumption.

Due to the fact that GC are commercialized in a variety of pharmaceutical forms and are administered in different ways, it is necessary to establish discrimination criteria to guarantee the therapeutic use of these drugs and to prevent doping.

Hypothesis:

Discrimination criteria between allowed and prohibited administrations of GC must be specific for each of the compounds. Further studies are needed to provide discrimination criteria related to oral administration of GC.

Objectives:

To conduct excretion studies with dexamethasone, methylprednisolone and deflazacort in order to define notification levels and wash-out periods after the administration of a single dose (DEX, MP and DEF) or repeated doses (DEX and MP) of these drugs.

Methods:

Non-randomized, open-label, pharmacokinetics clinical trial where a single dose of DEF, MP and DEX and also a multi-dose of DEX and MP will be administered orally to healthy volunteers (total n=50).

Condition or Disease	Intervention/Treatment	Phase
Healthy Volunteers	Drug: Methylprednisone Drug: Methylprednisone Drug: Deflazacort Drug: Dexamethasone Drug: Dexamethasone	Phase 1

Detailed Description

The World Anti-Doping Agency (WADA) has established a general notification level of 30 ng/mL for GC to discriminate allowed and not allowed administrations. However, recent studies have proven that the use of a unique criteria is not adequate given the diversity of administration routes, doses and pharmacokinetics and pharmacodynamics properties of each drug.

The goal of this study is to conduct additional studies using dexamethasone (DEX), methylprednisolone (MP) and deflazacort (DEF) in order to generate additional data of urinary concentrations and wash-out periods after single and repeated oral doses of these drugs.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

50 participants

Allocation:

Non-Randomized

Intervention Model:

Parallel Assignment

Intervention Model Description:

Single-center, non-randomized, open-label clinical trial in healthy male volunteers. A single dose of DEX, MP and DEF, and multiple dose of DEX and MP will be administered to different subjects.Single-center, non-randomized, open-label clinical trial in healthy male volunteers. A single dose of DEX, MP and DEF, and multiple dose of DEX and MP will be administered to different subjects.

Masking:

None (Open Label)

Primary Purpose:

Other

Official Title:

Study of the Excretion of Orally Administered Corticosteroids for the Improval of the Detection of Said Substances in Anti-doping Controls

Actual Study Start Date :

Feb 26, 2021

Anticipated Primary Completion Date :

Feb 26, 2022

Anticipated Study Completion Date :

Feb 26, 2022

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Methylprednisone single-dose Subjects receive a single dose treatment. Urine samples will be collected until 5 days after administration in 10 fractions: 0-4h, 4-8h, 8-12h, 12-24h, 24-36h, 36-48h, 48-72h, 72-96h, 96-120h post-administration. Blood samples will be collected until 6 days after administration in 5 fractions: pre-administration and 24h, 48h, 72h and 120h post-administration.	Drug: Methylprednisone 12 mg of methylprednisone (3 pills of 4 mg each) administered orally in a single dose. Other Names: Urbason®
Experimental: Methylprednisone multiple-dose Subjects receive a multiple dose treatment. Urine samples will be collected until 7 days after administration in 20 fractions.	Drug: Methylprednisone 12 mg of methylprednisone (3 pills of 4 mg each) administered orally every 24 hours during 3 days. Other Names: Urbason®
Experimental: Deflazacort single-dose Subjects receive a single-dose treatment. Urine samples will be collected until 5 days after administration in 10 fractions: 0-4h, 4-8h, 8-12h, 12-24h, 24-36h, 36-48h, 48-72h, 72-96h, 96-120h post-administration. Blood samples will be collected until 6 days after administration in 5 fractions: pre-administration and 24h, 48h, 72h and 120h post-administration.	Drug: Deflazacort 30 mg of deflazacort (1 pill) administered orally in a single dose.
Experimental: Dexamethasone single-dose Subjects receive a single-dose treatment. Urine samples will be collected until 13 days after administration in 11 fractions: 0-4h, 4-8h, 8-12h, 12-24h, 24-36h, 36-48h, 48-72h, 72-96h, 96-120h, 120-144h post-administration. Blood samples will be collected until 9 days after administration in 6 fractions: pre-administration and 24h, 48h, 72h, 120h and 192h post-administration.	Drug: Dexamethasone 4 mg of dexamethasone (1 pill) administered orally in a single dose.
Experimental: Dexamethasone multiple-dose Subjects receive a multiple dose treatment. Urine samples will be collected until 10 days after administration in 34 fractions. Blood samples will be collected until 13 days after the first administration.	Drug: Dexamethasone 2 mg of dexamethasone (1/2 pill) administered orally every 12 hours during 5 days.

Outcome Measures

Primary Outcome Measures

Urine concentration of methylprednisone [0-4h (hours), 4-8h, 8-12h, 12-24h, 24-36h, 36-48h, 48-72h, 72-96h, 96-120h post-administration]
Concentration of methylprednisone in each fraction of urine samples
Urine concentration of methylprednisone metabolites [0-4h (hours), 4-8h, 8-12h, 12-24h, 24-36h, 36-48h, 48-72h, 72-96h, 96-120h post-administration]
Concentration of methylprednisone metabolites in each fraction of urine samples
Urine concentrations of deflazacort [0-4h (hours), 4-8h, 8-12h, 12-24h, 24-36h, 36-48h, 48-72h, 72-96h, 96-120h post-administration]
Concentration of deflazacort in each fraction of urine samples
Urine concentrations of deflazacort metabolites [0-4h (hours), 4-8h, 8-12h, 12-24h, 24-36h, 36-48h, 48-72h, 72-96h, 96-120h post-administration]
Concentration of deflazacort metabolites in each fraction of urine samples
Urine concentration of dexamethasone [0-4h (hours), 4-8h, 8-12h, 12-24h, 24-36h, 36-48h, 48-72h, 72-96h, 96-120h, 120-144h post-administration]
Concentration of dexamethasone in each fraction of urine samples
Urine concentration of dexamethasone metabolites [0-4h (hours), 4-8h, 8-12h, 12-24h, 24-36h, 36-48h, 48-72h, 72-96h, 96-120h, 120-144h post-administration]
Concentration of dexamethasone metabolites in each fraction of urine samples

Secondary Outcome Measures

Plasma concentrations of drug metabolites [Before drug administration and at 0.5h (hours), 1h, 1.5h, 2h, 3h, 4h, 6h, 8h, 24h, 48h, 72h, 120h, 192h post-administration]
Concentrations of drug metabolites (DEX, MP, DEF) in plasma
Plasma concentrations of cortisol [Before drug administration and at 0.5h (hours), 1h, 1.5h, 2h, 3h, 4h, 6h, 8h, 24h, 48h, 72h, 120h, 192h post-administration]
Concentrations of cortisol in plasma
Plasma concentrations of endogen steroids [Before drug administration and at 0.5h (hours), 1h, 1.5h, 2h, 3h, 4h, 6h, 8h, 24h, 48h, 72h, 120h, 192h post-administration]
Concentrations of endogen steroids in plasma [testosterone (T), epitestosterone (E), androsterone (A), etiocholanolone (Etio), 5α-androstane-3α,17β-diol (5aAdiol), 5β-androstane-3α,17β-diol (5bAdiol), and the quotients T/E, A/T, A/Etio, 5aAdiol/5bAdiol and 5aAdiol/ET]
Plasma concentrations of testosterone [Before drug administration and at 0.5h (hours), 1h, 1.5h, 2h, 3h, 4h, 6h, 8h, 24h, 48h, 72h, 120h, 192h post-administration]
Concentrations of testosterone in plasma
Plasma concentrations of epitestosterone [Before drug administration and at 0.5h (hours), 1h, 1.5h, 2h, 3h, 4h, 6h, 8h, 24h, 48h, 72h, 120h, 192h post-administration]
Concentrations of epitestosterone in plasma
Plasma concentrations of androsterone [Before drug administration and at 0.5h (hours), 1h, 1.5h, 2h, 3h, 4h, 6h, 8h, 24h, 48h, 72h, 120h, 192h post-administration]
Concentrations of androsterone in plasma
Plasma concentrations of etiocholanolone [Before drug administration and at 0.5h (hours), 1h, 1.5h, 2h, 3h, 4h, 6h, 8h, 24h, 48h, 72h, 120h, 192h post-administration]
Concentrations of etiocholanolone (Etio) in plasma
Plasma concentrations of 5α-androstane-3α,17β-diol [Before drug administration and at 0.5h (hours), 1h, 1.5h, 2h, 3h, 4h, 6h, 8h, 24h, 48h, 72h, 120h, 192h post-administration]
Concentrations of 5α-androstane-3α,17β-diol (5aAdiol) in plasma
Plasma concentrations of 5β-androstane-3α,17β-diol [Before drug administration and at 0.5h (hours), 1h, 1.5h, 2h, 3h, 4h, 6h, 8h, 24h, 48h, 72h, 120h, 192h post-administration]
Concentrations of 5β-androstane-3α,17β-diol (5bAdiol) in plasma
Quotient testosterone/epitestosterone in plasma [Before drug administration and at 0.5h (hours), 1h, 1.5h, 2h, 3h, 4h, 6h, 8h, 24h, 48h, 72h, 120h, 192h post-administration]
Concentrations of testosterone/epitestosterone (T/E) in plasma
Quotient androsterone/testosterone in plasma [Before drug administration and at 0.5h (hours), 1h, 1.5h, 2h, 3h, 4h, 6h, 8h, 24h, 48h, 72h, 120h, 192h post-administration]
Concentrations of androsterone/testosterone (A/T) in plasma
Quotient androsterone/Etio in plasma [Before drug administration and at 0.5h (hours), 1h, 1.5h, 2h, 3h, 4h, 6h, 8h, 24h, 48h, 72h, 120h, 192h post-administration]
Concentrations of androsterone/etiocholanolone (A/Etio) in plasma
Quotient 5aAdiol/5bAdiol in plasma [Before drug administration and at 0.5h (hours), 1h, 1.5h, 2h, 3h, 4h, 6h, 8h, 24h, 48h, 72h, 120h, 192h post-administration]
Concentrations of 5α-androstane-3α,17β-diol/5β-androstane-3α,17β-diol (5aAdiol/5bAdiol) in plasma
Quotient 5aAdiol/ET in plasma [Before drug administration and at 0.5h (hours), 1h, 1.5h, 2h, 3h, 4h, 6h, 8h, 24h, 48h, 72h, 120h, 192h post-administration]
Concentrations of 5α-androstane-3α,17β-diol/etiocholanolone (5aAdiol/ET) in plasma
Hemoglobin concentration [At -72h (hours), -48h, -24h (before first administration), and at 0h, 1h, 3h, 6h after each dose (in multiple-dose treatments)]
Variation of hemoglobin concentrations in blood
Hematocrit [At -72h (hours), -48h, -24h (before first administration), and at 0h, 1h, 3h, 6h after each dose (in multiple-dose treatments)]
Variation of hematocrit value in blood
Mean corpuscular hemoglobin [At -72h (hours), -48h, -24h (before first administration), and at 0h, 1h, 3h, 6h after each dose (in multiple-dose treatments)]
Variation of mean corpuscular hemoglobin (MCH) levels in blood
Mean corpuscular volume of erythrocytes [At -72h (hours), -48h, -24h (before first administration), and at 0h, 1h, 3h, 6h after each dose (in multiple-dose treatments)]
Variation of mean corpuscular volume of erythrocytes (MCV) levels in blood
Erythrocytes count [At -72h (hours), -48h, -24h (before first administration), and at 0h, 1h, 3h, 6h after each dose (in multiple-dose treatments)]
Variation of erythrocytes count in blood
Standard deviation of the range of distribution of erythrocytes [At -72h (hours), -48h, -24h (before first administration), and at 0h, 1h, 3h, 6h after each dose (in multiple-dose treatments)]
Variation of standard deviation of the range of distribution of erythrocytes
Platelet count [At -72h (hours), -48h, -24h (before first administration), and at 0h, 1h, 3h, 6h after each dose (in multiple-dose treatments)]
Variation of platelet count in blood
Reticulocyte count [At -72h (hours), -48h, -24h (before first administration), and at 0h, 1h, 3h, 6h after each dose (in multiple-dose treatments)]
Variation of reticulocyte count in blood
Fraction of immature reticulocytes [At -72h (hours), -48h, -24h (before first administration), and at 0h, 1h, 3h, 6h after each dose (in multiple-dose treatments)]
Variation of immature reticulocytes fraction in blood

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 55 Years

Sexes Eligible for Study:

Male

Accepts Healthy Volunteers:

Yes

Inclusion Criteria:

Male volunteers aged between 18 and 55 years.
Able to understand and accept the trial procedures and able to sign an informed consent prior to any study-mandated procedure.
History and physical examination that demonstrate not presenting organic or psychiatric disorders.
ECG, blood and urine tests performed before the experimental session within normal limits. Minor or occasional variations of these limits will be allowed if, in the opinion of the Principal Investigator and taking into account the state of science, they have no clinical significance, do not pose a risk to the subject and do not interfere in the product evaluation. These variations and their non-relevance will be specifically justified in writing.
Body mass index (weight/height^2) between 19 and 27 kg/m2 and weight between 50 and 100 kg. BMI of 27-28 kg/m2 may be included according to Principal Investigator's criteria.

Exclusion Criteria:

Failure to meet inclusion criteria.
History of allergy, idiosyncrasy, hypersensitivity or adverse reactions to glucocorticoids or any of the excipients. Serious adverse reactions to any drug.
Contraindications to treatment with study drugs (according to the respective summary of product characteristics, SmPC).
Clinical background or evidence of gastrointestinal, hepatic, renal disorder or others that may involve an alteration of the absorption, distribution, metabolism or excretion of the drug.
Clinical background or evidence of psychiatric disorders, alcoholism, drug abuse or habitual consumption of psychoactive drugs.
Having participated in another clinical trial with medication in the three months prior to the start of the study.
Having donated blood in the three months prior to the start of the study, in the event that blood extractions are made.
Having suffered some organic disease or major surgery in the six months prior to the start of the study.
Clinical background or evidence of cardiovascular, respiratory, renal, hepatic, endocrine, gastrointestinal, hematological, neurological, or other acute or chronic diseases that, in the opinion of the Principal Investigator or the collaborators designated by him/her, may pose a risk to the subjects or may interfere with the objectives of the study. Especially osteoporosis, hypertension, Cushing syndrome, diabetes mellitus, and viral infections such as herpes or varicella.
Having taken medication regularly in the month prior to the study sessions -in case of glucocorticoids 3 months prior- with the exception of vitamins, herbal remedies or dietary supplements that, in the opinion of the Principal Investigator or the collaborators designated by him/her, may not pose a risk to the subjects or may not interfere with the objectives of the study. Treatment with a single dose of symptomatic medication in the week prior to the study sessions will not be a reason for exclusion if it is assumed that the drug has been completely eliminated on the day of the experimental session.
Smokers of more than 20 cigarettes a day in the 3 months before the study.
Consumption of more than 40 g of alcohol daily.
Consumers of more than 5 coffees, teas, cola drinks, or other stimulant drinks or with xanthines daily in the 3 months prior to the study start.
Being unable to understand the nature, consequences of the trial and the procedures that are asked to follow.
Positive serology for hepatitis B, C or HIV.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	IMIM (Hospital del Mar Medical Research Institute)	Barcelona		Spain	08003

Sponsors and Collaborators

Parc de Salut Mar

Investigators

Principal Investigator: Rosa Ventura Alemany, PharmD, PhD, IMIM (Hospital del Mar Medical Research Institute)
Principal Investigator: Ana M Aldea Perona, MD, PhD, IMIM (Hospital del Mar Medical Research Institute)