World Anti-Doping Agency Guidelines Research Articles

(381) Infertility, Erectile Dysfunction, and Hypogonadism Medications in the NFL: A Comprehensive Analysis of the Substance Abuse Policy, Violation Penalties, and Therapeutic Use Exemptions

Abstract Introduction The National Football League (NFL) faces countless challenges in maintaining a fair and competitive playing field while protecting player health. One aspect of concern involves the use of medications to treat infertility, erectile dysfunction (ED), and hypogonadism, which can potentially alter and enhance athletic performance. The NFL's Substance Abuse Policy governs the use of such medications and imposes strict penalties for violations. Several important players have been affected by these rules while attempting treatment for legitimate medical conditions. This project explored the presence of infertility, ED, and hypogonadism treatments among NFL players, assessed the penalties for their misuse, and analyzed the process for obtaining Therapeutic Use Exemptions (TUEs). Objective To provide in-depth analysis of the NFL's Substance Abuse Policy involving medications for infertility, ED, and hypogonadism treatment. Specifically, we evaluated the presence of specific medications in question as compared with the guidelines established by the World Anti-Doping Agency (WADA), examined the penalties associated with misuse, and investigated the procedures for obtaining TUEs. Methods We obtained a copy and conducted a thorough analysis of NFL’s Substance Abuse Policy, focusing on the presence of commonly prescribed medications to treat infertility, ED, and hypogonadism. This was compared to existing WADA guidelines. We then evaluated specific testing procedures and penalties associated with their use. We finally analyzed and delineated the methodology for obtaining a TUE. Results Our analysis of the Substance Abuse Policy revealed 97 prohibited substances encompassing Anabolic/Androgenic Steroids, Protein and Peptide Hormones, Anabolic Agents including Beta-2 Agonists, Anti-Estrogenic Agents, Selective Androgen Receptor Modulators (SARMs). This list was found to be 98% consistent with existing WADA guidelines. Erectile Dysfunction medications were allowed, specifically Viagra, Cialis, and Levitra. Penalties for violating League Policy ranged from fines (calculated using player-specific salary), suspension, bonus forfeiture, and banishment. Regarding TUEs, specifically for hypogonadism, the application process proved to be complex, requiring substantial medical documentation, laboratory testing including FSH, LH, and semen analysis, and expert review. Obtaining a TUE additionally required annual renewal as well as regular serum testing and medical visits. Conclusions The use of medications treating infertility and hypogonadism among NFL players is a valid medical concern. While potential for abuse exists, many players qualify for treatment based on current medical guidelines. The Substance Abuse Policy was comprehensive, including all major infertility and hypogonadism medications while allowing use of common ED medications. Penalties for violations were strict but accompanied by associated review and appeal processes. The TUE system, while complex and time-intensive, provided pathways for players with genuine medical needs to access necessary treatments while maintaining organizational oversight. This study showed the delicate balance maintained by a multi-billion-dollar industry in promoting fair play while simultaneously allowing players to obtain legitimate medical treatments. Further research and collaboration between medical professionals, players, and league officials is needed to further refine this process for future generations. Disclosure No.

Capillary blood as a complementary matrix for doping control purposes. Application to the definition of the individual longitudinal profile of IGF-1

We present a novel procedure to monitor the fluctuations of the levels of IGF-1 in capillary blood in the framework of doping control analysis. Being an endogenous hormone, direct methods are not applicable, so the most effective way to detect the intake of the exogenous hormone would be based on the longitudinal monitoring of the athlete. We have therefore followed the individual variability, in four subjects (two males and two females), of the levels of IGF-1 in capillary blood samples collected three times per day for five days, then once a week for at least two months. Analyses were performed by liquid chromatography coupled to tandem mass spectrometry following a bottom-up approach. The whole protocol, from the sample collection to the instrumental analysis, was validated according to the World Anti-Doping Agency's guidelines and ISO17025. The analytical protocol showed to be fit for purpose in terms of sensitivity (LOD 25 ng/mL and LOI 35 ng/mL), selectivity (no interferences were detected at the retention time of IGF-1 and the internal standard), and repeatability (CV<10%). The linearity was confirmed in the range of 50–1000 ng/mL (correlation coefficient R2 >0.995, with a % relative bias of the experimental concentration of the different calibrators used for the estimation of the linearity lower than 20% for the lowest level and than 15% for the other levels). Stability studies were also performed, also to establish the optimal conditions for transport and storage: samples were stable at 4 °C for up to 72 h and at −20 °C and −80 °C for up to three months. Our preliminary results indicate that, in all subjects, the levels of IGF-1 did not present significant circadian fluctuations and remained stable during the entire period of the study (2–3 months, depending on the subject). The stability over time of IGF-1 levels in capillary blood indicates the possibility of detecting the intake of the non-endogenous hormone based on a longitudinal approach, as it is modeled in the framework of the endocrinological module of the athlete biological passport.

Removal of the influence of plasma volume fluctuations for the athlete biological passport and stability of haematological variables in active women taking oral contraception.

The haematological module of the athlete biological passport (ABP) monitors longitudinal haematological variations that could be indicative of blood manipulation. This study applied a multi‐parametric model previously validated in elite cyclists to compare inferred and actual PV variations, whereas the potential influence of the oral contraceptive pill (OCP) cycle on the ABP blood biomarkers and plasma volume (PV) in 14 physically active women taking OCPs was also investigated. Blood and serum samples were collected each week for 8 weeks, and the ABP haematological variables were determined according to the World Anti‐Doping Agency guidelines. Transferrin (sTFN), ferritin (FERR), albumin (ALB), calcium (Ca), creatinine (CRE), total protein (TP) and low‐density lipoprotein (LDL) were additionally computed as ‘volume‐sensitive’ variables in a multivariate analysis to determine individual estimations of PV variations. Actual PV variations were indirectly measured using a validated carbon monoxide rebreathing method. We hypothesised ABP markers to be stable during a standard OCP cycle and estimated PV variations similar to measured PV variations. Measured PV variations were in good agreement with the predictions and allowed to explain an atypical passport finding (ATPF). The ABP biomarkers, Hbmass and PV were stable over 8 weeks. Significant differences occurred only between Week 7 and Week 1, with lower levels of haemoglobin concentration ([Hb]), haematocrit (HCT) and red blood cell count (RBC)(−4.4%, p < 0.01; −5.1%, p < 0.01; −5.2%, p < 0.01) and higher levels of PV at week 7 (+9%, p = 0.05). We thus concluded that estimating PV variations may help interpret individual ABP haematological profiles in women.

Sensitive ‘two-steps’ competitive assay for gonadotropin-releasing hormone detection via SPR biosensing and polynorepinephrine-based molecularly imprinted polymer

The work reports an innovative bioassay for the detection of gonadorelin in urine, a gonadotropin-releasing hormone agonist widely used in fertility medicine and to treat hormonal dysfunctions. Gonadorelin is also a synthetic hormone listed by the World Anti-Doping Agency (WADA) and of interest in anti-doping controls. The main novelty relies on the development of a biocompatible, stable, and low-cost biomimetic receptor alternative to classic antibodies. Starting from norepinephrine monomer, a highly selective and sensitive molecularly imprinted polymer (MIP) was developed and optimized for optical real-time and label-free SPR biosensing. The selectivity has been addressed by testing a series of peptides, from high to low similarity, both in terms of molecular weight and primary sequence. Due to the very low molecular weight of gonadorelin (1182 Da), a ‘two-steps’ competitive assay was developed. Particular attention has been paid to the design of the competitor and its binding affinity constant towards the MIP, being a key step for the success of the competitive strategy. The SPR assay was first optimized in standard conditions and finally applied to untreated urine samples, achieving the sensitivity required by WADA guidelines. The MIP, tested in parallel with a monoclonal antibody, gave comparable results in terms of affinity constants and selectivity towards possible interfering analytes. However, the biomimetic receptor appears clearly superior in terms of sensitivity and reproducibility. This, together with its preparation simplicity, the extremely low-cost of the monomer and its reusability for hundreds of measurements, make polynorepinephrine-based MIPs powerful rivals to immune-based approaches in the near future for similar applications.

UPLC-MS-Based Procedures to Detect Prolyl-Hydroxylase Inhibitors of HIF in Urine.

This article presents newly developed screening and confirmation analytical procedures to detect the misuse of nine prolyl-hydroxylase inhibitors of the hypoxia-inducible factor: daprodustat, desidustat, FG2216, IOX2, IOX4, JNJ-42041935, molidustat, roxadustat and vadadustat, targeting either the parent drugs and/or their main metabolite(s). For the sample pretreatment, different extraction protocols and technologies were evaluated. The instrumental analysis was performed by ultra-high-performance liquid chromatography coupled to either high- or low-resolution mass spectrometry. The chromatographic separation was performed on a C18 column, employing water and acetonitrile, both containing 0.1% formic acid, as mobile phase. Detection was achieved using as analyzer either a triple quadrupole or an Orbitrap, with positive and negative electrospray ionization and different acquisition modes. Validation of the procedures was performed according to the ISO 17025 and World Anti-Doping Agency guidelines. The methods do not show any significant interference at the retention times of the analytes of interest. The extraction efficiency was estimated to be greater than 75% for all analytes and the matrix effect smaller than 35%. Detection capability was determined in the range of 0.25-2.0 for the screening procedure and in the range of 0.5-2.0ng/mL for the confirmation procedure, that is, in a range of concentration small enough to reveal the abuse of the compounds considered, in case they are used as performance-enhancing agents. The repeatability of the relative retention times (CV%<0.5) and of the relative abundances of the selected ion transitions, considered only in the case of triple quadrupole (CV%<15), was confirmed to be fit for purpose to ensure the unambiguous identification of all the target analytes in human urine. The applicability of the newly developed methods was verified by the analysis of urine samples containing molidustat, roxadustat or daprodustat. The developed procedures enabled to detect the compounds under investigation and their main metabolites.

Fully automated dried blood spot sample preparation enables the detection of lower molecular mass peptide and non-peptide doping agents by means of LC-HRMS

The added value of dried blood spot (DBS) samples complementing the information obtained from commonly routine doping control matrices is continuously increasing in sports drug testing. In this project, a robotic-assisted non-destructive hematocrit measurement from dried blood spots by near-infrared spectroscopy followed by a fully automated sample preparation including strong cation exchange solid-phase extraction and evaporation enabled the detection of 46 lower molecular mass (< 2 kDa) peptide and non-peptide drugs and drug candidates by means of LC-HRMS. The target analytes included, amongst others, agonists of the gonadotropin-releasing hormone receptor, the ghrelin receptor, the human growth hormone receptor, and the antidiuretic hormone receptor. Furthermore, several glycine derivatives of growth hormone–releasing peptides (GHRPs), arguably designed to undermine current anti-doping testing approaches, were implemented to the presented detection method. The initial testing assay was validated according to the World Anti-Doping Agency guidelines with estimated LODs between 0.5 and 20 ng/mL. As a proof of concept, authentic post-administration specimens containing GHRP-2 and GHRP-6 were successfully analyzed. Furthermore, DBS obtained from a sampling device operating with microneedles for blood collection from the upper arm were analyzed and the matrix was cross-validated for selected parameters. The introduction of the hematocrit measurement method can be of great value for doping analysis as it allows for quantitative DBS applications by managing the well-recognized “hematocrit effect.”Graphical abstract

Pharmacists as a Source of Advice on Medication Use for Athletes.

Background: The World Anti-Doping Agency (WADA) specifies substances that competitive sportspersons are not allowed to take. Some of these substances are contained in common medicines used in everyday medical practice and could be used by athletes by accident. Objectives: This study aimed to explore pharmacists’ knowledge and confidence in guiding athletes about the use of medicines in professional sport. Methods: Registered pharmacists in Australia were invited to participate in an online survey. The survey had five domains and aimed to identify pharmacists’ demographic information, interest in sport, familiarity with WADA guidelines, knowledge on prohibited drug classes, and their opinion about the role of pharmacists in educating athletes on medication use. Descriptive statistics were provided and where appropriate, Chi-square, Mann–Whitney and independent t-test were used to identify potential associations and difference between means. Results: One hundred and thirty-five pharmacists (response rate of 10.6%) completed the survey, with the majority indicating that they were not confident in advising athletes on medication use. Although most respondents believed that pharmacists have a role in the education of athletes to help avoid unintentional doping, only about a quarter indicated that they had sufficient knowledge to advise athletes. About one-half of the respondents could provide fully correct answers when asked to identify the WADA status of some commonly used drugs. Conclusions: The results of the survey indicate that upskilling is required to enable pharmacists in Australia to provide accurate medication advice to professional athletes.

Detection of 5α-reductase inhibitors by UPLC-MS/MS: Application to the definition of the excretion profile of dutasteride in urine.

An analytical procedure based on ultra-performance liquid chromatography-mass spectrometry was developed to screen and to confirm dutasteride and its metabolites in human urine. Sample preparation included an enzymatic hydrolysis followed by solid-phase extraction using the strong cation exchange cartridges OASIS® MCX. The chromatographic separation was carried out on C18 column, employing as mobile phases ultra purified water and acetonitrile, both containing 0.1% formic acid. Detection was achieved using a triple quadrupole as a mass spectrometric analyzer, with positive ion electrospray ionization and multiple reaction monitoring as acquisition mode. The analytical procedure developed was validated according to ISO 17025 and World Anti-Doping Agency guidelines. The extraction efficiency was estimated to be greater than 75% for both dutasteride and its hydroxylated metabolites. Detection capability was determined in the range of 0.1-0.4ng/mL. Specificity and repeatability of the relative retention times (CV%<0.5) and of the relative abundances of the characteristic ion transitions selected (CV%<10) were confirmed to be fit for purpose to ensure the unambiguous identification of dutasteride and its metabolites in human urine. The developed method was used to characterize the urinary excretion profile of dutasteride after both chronic and acute administration of therapeutic doses. After chronic administration, dutasteride and its hydroxylated metabolites were easily detected and confirmed. After acute administration, instead, only the two hydroxylated metabolites were detected for 3-4days.

Urinary excretion studies of meldonium after multidose parenteral application

Meldonium is a drug exhibiting cardioprotective and anti-ischemic effects. Due to its potential performance-enhancing benefit in sports, meldonium was added to the World Anti-Doping Agency list of prohibited substances in 2016. Since then, a high number of adverse analytical findings reported on meldonium has questioned meldonium`s detection time in urine. Hence, the objective of the current study was to characterize the pharmacokinetic urinary excretion pattern of meldonium when administered as multiple intravenous injections. Three injections of 250 mg meldonium were given over a time period of five days to six healthy volunteers and urine samples were collected for eight months after the last injection of the drug. For the quantification of meldonium in urine, a liquid chromatography-tandem mass spectrometry method was fully validated according to the World Anti-Doping Agency guidelines in terms of specificity, matrix interferences, intra- and inter-day precision, accuracy, carry-over, robustness, linearity, limit of detection, and limit of quantification. The assay was successfully applied to the pharmacokinetic study. A three-compartment model was found to best describe the pharmacokinetics of meldonium with average alpha, beta, and gamma half-lives of 1.4 h, 9.4 h, and 655 h, respectively. The detection time in urine varied between 94 and 162 days.

Development and validation of a multidimensional gas chromatography/combustion/isotope ratio mass spectrometry-based test method for analyzing urinary steroids in doping controls

The misuse of the steroid hormone testosterone for performance enhancement has been frequently reported in the past, and its administration is prohibited in sports according to the regulations of the World Anti-Doping Agency (WADA). Testosterone is produced endogenously in human. Endogenous and exogenous testosterone together with their metabolites can be unambiguously distinguished by means of their carbon isotope ratios if compared to endogenous reference compounds. Established isotope ratio mass spectrometry methods for analyzing urinary steroids for doping control purposes consist of up to two time-consuming HPLC purification steps to achieve the required purity of all analytes. In order to accelerate the sample preparation, multidimensional gas chromatography was applied. This technique is known to be suitable for the separation of complex matrices. Multidimensional gas chromatography consists of two gas chromatographs connected by a pressure-controlled heart-cutting device. In the first dimension, a less polar capillary column was installed for peak purification. In the second dimension, separation was achieved employing a column of medium polarity. Retention time stability and transfer windows were monitored by a flame ionization detector. Detection was performed simultaneously by isotope ratio mass spectrometry and a single quadrupole mass spectrometer for analyte identity confirmation and assessment of peak purity.Instead of two working days required for the HPLC-based routine method, the sample preparation is shortened by the herein presented approach to one working day. For glucuronic acid-conjugated steroids, sample pretreatment is based on solid-phase extraction, liquid-liquid extraction, enzymatic hydrolysis, and derivatization of the target analytes to their corresponding acetates. These steroid acetates are divided according to their polarity into two fractions by solid phase extraction. Further, sulfoconjugated steroids are processed by Pseudomonas aeruginosa arylsulfatase and extracted following a recently established procedure.Following WADA guidelines, the method was validated by determining the parameters linear range, limit of quantification, intra- and interday precision, accuracy and specificity utilizing linear mixing models. Additionally, a reference population (n = 74) was investigated and the obtained data were compared to the established method. An excretion study was also conducted with 4-androstenedione to prove the fit for purpose of the methodology. The results demonstrate that the method is suitable for an application in routine doping control analysis.

Method for Screening and Confirming Meldonium in Human Urine by High- Resolution Mass Spectrometry and Identification of Endogenous Interferences for Anti-Doping Testing

Meldonium is a drug for treating ischemia by expanding the arteries but it can also enhance the performance of sports players. The World Anti-Doping Agency (WADA) has included it in the list of prohibited substances since 2016. Meldonium is one of the challenging substances for anti-doping testing because it is difficult to recover by general liquid-liquid or solid phase extraction due to its permanent charge and high polarity. Therefore, high-performance liquid chromatography (HPLC) is cur-rently used by injecting a diluted urine sample (known as the “dilute-and-shoot” strategy). There is no loss of target compounds in the extraction/cleanup procedure but its high matrix effect could interfere in their separation or detection from the endogenous urinary compounds. We report a single method using high-resolution mass spectrometry that can be used for both screening and confirmation, which follows the “dilute-and-shoot” strategy. In this method, the endogenous compounds` interfering peaks in the mass spectrum are separated at a high resolution of FWHM 140,000, and the results are suitable for substance detection follow-ing the WADA guidelines. The interferences in the obtained mass spectrum of the urine matrix are identified as acetylcholine, lysine, and glutamine by further analysis and database searching. Validation of the method is performed in routine anti-doping testing, and the limit of detection is 50 ng/mL. This method uses simple sample preparation and a general reverse phase HPLC column, and it can be easily applied to other substances.

Simple quantitation of formoterol and 11-nor-Δ(9)-tetrahydrocannabinol-9-carboxylic acid in human urine by liquid chromatography-tandem mass spectrometry in doping control.

11-nor-Δ(9)-tetrahydrocannabinol-9-carboxylic acid (THC-COOH) and formoterol are newly revised prohibited threshold substances (150 ng/mL for THC-COOH and 40 ng/mL for formoterol) by the World Anti-Doping Agency (WADA). In continuation of our direct quantitation work of the prohibited threshold substances, direct LC-MS/MS methods combined with a simple sample preparation procedure have been developed and validated for the measurement of these two threshold substances in urine samples. After the enzymatic hydrolysis of urine samples, the resulting samples were diluted with acetonitrile and centrifuged. The supernatant was directly analyzed by LC-MS/MS using the selected reaction monitoring mode. The calibration curve range of the assay was ranged over 50-200% of the threshold value according to WADA guidelines. The limit of detection and limit of quantification were 6.1 and 18.4 ng/mL for THC-COOH and 2.0 and 6.2 ng/mL for formoterol, respectively. Intra- and inter-day precisions were between 2.08% and 7.28% and the accuracies ranged from 95.16% to 104.49%. The present methods were successfully applied to the analysis of the proficiency test samples.

Impact of Changes in Anti-doping Regulations (WADA Guidelines) on Asthma Care in Athletes

To investigate how changes to the World Anti-Doping Agency (WADA) guidelines on asthma medication requests have impacted the management of asthmatic athletes in Portugal. Retrospective analysis of asthma medication requests submitted in 2008 to 2010. Portuguese Anti-Doping Authority database. Athletes requesting the use of inhaled corticosteroids and/or β2-agonists. Demographic, therapeutic, and diagnostic test data. Yearly changes in number of asthma medication requests and diagnostic procedures. We analyzed 326 requests: 173 abbreviated Therapeutic Use Exemptions (TUEs) in 2008 (objective tests not required), 9 Declaration of Use (DoU) and 76 TUEs in 2009, and 39 DoU and 29 TUEs in 2010. Spirometry was performed in 87% and 37% of athletes in 2009 and 2010, respectively; the corresponding figures for bronchoprovocation were 59% and 16%, almost all positive in both years. Applications for inhaler use have decreased by approximately half since objective asthma testing became mandatory. Our findings show that WADA guidelines have an impact on asthmatic athletes care: In 2009 a more rigorous screening was possible, leading to withdrawal of unnecessary medication. Constant changes, however, jeopardize this achievement and nowadays introduce safety issues stemming from the unsupervised use of inhaled β2-agonists.

Detection of doping with rhGH: Excretion study with WADA‐approved kits

The detection of recombinant human growth hormone (rhGH) doping using the World Anti-Doping Agency (WADA) approved kits is reported in this research. Twenty-five young male students were selected and divided randomly into two groups with six belonging to the placebo and nineteen to the administration group. Thirteen volunteers in one group were administered with a Chinese preparation of rhGH while six volunteers included in the other group were given rhGH made in Switzerland. Both preparations were administered at a dose of 0.1 IU/kg body weight, one injection per day for 14 consecutive days. Blood samples were collected using WADA guidelines and all blood samples were analyzed with WADA-approved Kits 1 and 2. The time window for detection of rhGH doping using WADA-approved kits and criteria are discussed. Based on the comparison of the data obtained from this excretion study and from our routine (Chinese population as reference), consideration of the recent WADA criteria for rhGH AAF (Analytical Adverse Findings) is reported statistically. A comparison of data obtained from the two sample groups administered with pharmaceutical preparations, one Chinese rhGH (GenHeal®, S19990019, 1.6 mg (4 IU), Shanghai, China) obtained from prokaryotic cells and the other (Saizen®, S20080036, 1.33 mg (4 IU), Laboratoires Serone S.A., Switzerland) from eukaryotic cells is reported and did not show any significant difference for the detection of doping with rhGH.

Validation of a GC/MS method for the detection of two quinolinone-derived selective androgen receptor modulators in doping control analysis

Selective androgen receptor modulators (SARMs) represent an emerging class of drugs likely to be abused in sport. For clinical applications, these substances provide a promising alternative to testosterone-replacement therapies and their advantages include oral bioavailability, androgen receptor specificity, tissue selectivity, and the absence of steroid-related side effects. Although not yet commercially available, since January 2008 SARMs have been included on the prohibited list issued yearly by the World Anti-Doping Agency (WADA), so control laboratories need to update their procedures to detect either the parent drugs or their metabolites. Within this context, two quinolinone SARM models were synthesized and automatically characterized to update the existing routine screening procedures. The conditions for the new target analytes are compatible with the existing laboratory protocols used for both in-competition and out-of-competition controls and can be included in them. Validation parameters according to ISO 17025 and WADA guidelines were successfully determined. For analytical determinations, spiked urine samples were hydrolyzed and extracted at pH 9.6 with 10 mL of tert-butyl methyl ether. Then, the analytes were subsequently converted into trimethylsilyl derivatives and detected by gas chromatography-mass spectrometry. The absence of interferents, together with excellent repeatability of both retention times and the relative abundances of diagnostic ions, allowed proper identification of all SARM analytes. The analytes' quantification was linear up to 500 ng/mL and precision criteria were satisfied (coefficient of variation less than 25% at 10 ng/mL). The limits of detection were 1 ng/mL for both SARMs, whereas recovery values were between 95.5 and 99.3%. The validated method can be efficiently used for urine screening of the 2-quinolinone-derived SARMs tested.

Stability and robustness of blood variables in an antidoping context

With the setting up of the newly Athlete's Biological Passport antidoping programme, novel guidelines have been introduced to guarantee results beyond reproach. We investigated in this context, the effect of storage time on the variables commonly measured for the haematological passport. We also wanted to assess for these variables, the within and between analyzer variations. Blood samples were obtained from top level male professional cyclists (27 samples for the first part of the study and 102 for the second part) taking part to major stage races. After collection, they were transported under refrigerated conditions (2 °C < T < 12 °C), delivered to the antidoping laboratory, analysed and then stored at approximately 4 °C to conduct analysis at different time points up to 72 h after delivery. A mixed-model procedure was used to determine the stability of the different variables. As expected haemoglobin concentration was not affected by storage and showed stability for at least 72 h. Under the conditions of our investigation, the reticulocytes percentage showed a much better stability than previous published data (> 48 h) and the technical comparison of the haematology analyzer demonstrated excellent results. In conclusion, our data clearly demonstrate that as long as the World Anti-Doping Agency's guidelines are followed rigorously, all blood results reach the quality level required in the antidoping context.

Rheumatological prescribing in athletes: a review of the new World Anti-Doping Agency guidelines.

Rheumatologists, with their musculoskeletal background, often care for athletes. The effect of a positive anti-doping test, whether through illegitimate use or accidental prescribing of banned drugs, is devastating to an athlete's career. It is therefore incumbent upon rheumatologists to be aware of issues relating to drugs in sport. This involves both therapeutic drugs and doping. It is vital to ensure that any substance prescribed should be approved for use and should not adversely affect (or benefit) the athlete's performance. In March 2004, 5 months prior to the 2004 Olympic Games in Athens, the joint World Anti-Doping Agency/International Olympic Committee published the revised list of banned substances in athletes. This article aims to provide an overview of the current status of medications commonly prescribed in rheumatological practice.