Implementing clinical operationalization of sarcopenia: The contribution of WHO ICOPE program.

Authors: ROLLAND, YVES - Gerontopole De Toulouse Center Hospital University; FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; LANDI, FRANCESCO - Università Cattolica Del Sacro Cuore; VELLAS, BRUNO - Gerontopole De Toulouse Center Hospital University

Submitted to: Journal of Nutrition Health and Aging
Publication Type: Other
Publication Acceptance Date: 4/25/2024
Publication Date: 5/6/2024
Citation: Rolland, Y., Fielding, R., Landi, F., Vellas, B. 2024. Implementing clinical operationalization of sarcopenia: The contribution of WHO ICOPE program.. Journal of Nutrition Health and Aging. http://doi.org/10.1016/j.jnha.2024.100257.
DOI: https://doi.org/10.1016/j.jnha.2024.100257

Interpretive Summary:

Technical Abstract: In 2016, sarcopenia was recognized as a disease with an ICD-code M62.84 (1) in the same as did previously other body composition changes such as obesity (ICD-code E66.9) or osteoporosis (ICD-code M81.0). This important advance followed nearly 30 years of mainly epidemiological work and foreshadowed significant therapeutic drug advances as well as the adoption by clinicians of a more systematic diagnostic approach to sarcopenia (1). In 2024, we must recognize that the enthusiasm generated by the recognition of sarcopenia as a disease has not translated into an increase in the diagnostic approach among clinicians nor by the hoped-for acceleration of clinical trials evaluating the effectiveness of innovative molecules for sarcopenia (Figure 1). To date, no drug has an indication for treating sarcopenia (2). A quick assessment on PubMed Medline of the current published randomized trials shows that therapeutic research is not in the expected dynamic (Figure 1). To date, 3 pharmacological molecules (excluding nutritional trials and vitamin D trials) have been tested in patients meeting the usual criteria for sarcopenia (EWGOS, ASWGOS, FNIH): The Selective Androgen Receptor Modulator (MK-0773) in 2013, Bimagrumab (BYM338) in 2017 and 2020 and an Angiotensin Converting Enzyme inhibitor (Perindopril) in 2022. In total, the cumulative number of sarcopenic patients having been included in a randomized drug trial is only 535 patients to date. Likewise, the therapeutic perspectives recorded on the Clinicaltrial.gov site demonstrate that very few RCTs include subjects meeting the sarcopenic criteria. Only 3 ongoing phase 2 randomized controlled trials include sarcopenic subjects. Two focus on sarcopenic patients in specific medical condition (cirrhosis or inflammatory context) (2). Only the SARA-Int study evaluates the effects of 20-hydroxyecdysone, an activator of the Mas receptor (MasR) in sarcopenic patients. Upstream, a multitude of molecules targeting various muscle biological pathways are in the preclinical phase, demonstrating that fundamental research on sarcopenia is dynamic and that therapeutic advances are possible.