Background
Methods
Search strategy and selection criteria
Inclusion criteria | Exclusion criteria |
---|---|
• peer-reviewed original articles with full-text available • no restriction regarding country and date • articles in English language or with English abstracts • articles that present proportions of original and/or counterfeit and/or substandard drugs | • abstract-only papers as preceding papers, conferences, editorials, and author response theses and books • articles without full text available • articles where the exact composition of analyzed IPEDs is not provided by the author • to increase the homogeneity, article with mixed samples (e.g., if the analysis includes different classes of IPED) in which data on AAS are < 75% of the analyzed substances |
Classification of prohibited substances and outcomes
WADA Class | Compound Class | Examples of compounds |
---|---|---|
S1 | Anabolic agents | E.g. anabolic androgenic steroids, other anabolic agents such as clenbuterol and selective androgen receptor modulators |
S2 | Peptide hormones, growth factors, related substances and mimetics | E.g. erythropoietins, chorionic gonadotropin, luteinizing hormone and growth hormone |
S3 | Beta-2 agonists | E.g. fenoterol, salbutamol and salmeterol |
S4 | Hormone and metabolic modulators | E.g. aromatase inhibitors (such as anastrozole, letrozole), anti-estrogenic substances (such as tamoxifen, clomiphene), myostatin inhibitors and insulins |
S5 | Diuretics and masking agents | E.g. desmopressin and acetazolamide |
Classification | Description and subclassification |
---|---|
Original | • Formulation detected fully matches the one declared on the label/ accurately labeled (qualitative) • Levels of active pharmaceutical ingredients (AI) detected are between the defined range of the declared formulation defined by the individual studya (quantitative) |
Substandard | • Formulation detected fully matches the one declared/ accurately labeled (qualitative) • Levels of AI detected are not between the acceptable range defined for original productsa (quantitative) • Subclassification (quantitative): - Over-concentrated: AI detected above defined range - Under-concentrated: AI detected below defined range |
Counterfeitb | • Formulation detected does not match the label/ not accurately labeled (qualitative) • Subclassification (qualitative): - Inert: no AI present - Substituted: different AI than labeled present - Adulterated: not all or more AI than the labeled AI present |
Data extraction and data analyses
Results
Selection of eligible studies
Quality appraisal of the included studies
Study characteristics
Characteristic | |
---|---|
Year of publication (mean) | 2017 (1997 to 2021) |
• Published within 5 years | • 10 (53%) |
• Published within 10 years | • 15 (79%) |
Sample information | |
• No. of samples included (mean; median) | • 285; 42.0 |
• Range of samples included (min; max) | • 8; 2818 |
• Cumulative sample size | • 5,413 |
Study design | |
• Retrospective database analysis | • 1 (5%) |
• Nonclinical laboratory studies | • 18 (95%) |
No. of included studies presenting | |
• Anabolic agents (S1) | • 17 (89%) |
• Mixed samples | • 2 (11%) |
No. of WHO regions and countries included | |
WHO Region of the Americas (AMR) | 7 (37%) |
• Brazil | • 7 (100%) |
European Region (EUR) | 12 (63%) |
• Switzerland | • 1 (8.3%) |
• France | • 1 (8.3%) |
• Italy | • 2 (16.7%) |
• Germany | • 3 (25%) |
• United Kingdom | • 1 (8.3%) |
• Czech Republic/Slovakia | • 2 (16.7%) |
• Belgium | • 1 (8.3%) |
• Austria | • 1 (8.3%) |
Sample collection methods | |
• Seized compounds by authorities | • 14 (74%) |
• Bought directly from the black market | • 4 (21%) |
• Received directly from gyms and users | • 1 (5%) |
Articles presenting outcomes | |
Counterfeit substances | 18 (95%) |
• Inert substances | • 10 (56%) |
• Substituted substances | • 10 (56%) |
• Adulterated substances | • 9 (50%) |
Substandard substances | 8 (41%) |
• Over-concentrated | • 4 (50%) |
• Under-concentrated | • 4 (50%) |
Original substances | |
• Qualitative analysis only | • 18 (95%) |
• Qualitative and quantitative analysis | • 7 (37%) |