Our Experience on Actovegin, is it Cutting Edge?

Abstract

Muscle injuries are one of the most common sport related injuries, their incidence varying from 30–55% in all sports injuries. They account for the loss of 90 training days and 15 matches per club per season in elite football (soccer). In recent years, the use of Actovegin^® in sports medicine has caused a lot of controversy in many sports disciplines. Although it is unlikely for this deproteinised substance to have oxygen-enhancing capacity, there is an anecdotal belief that Actovegin^® can increase an athlete's performance. Actovegin^® is produced by Nycomed Austria GmbH and has been used by doctors across Europe, China and Russia for over 60 years. Nevertheless, very little is known regarding the effects of Actovegin on muscle injuries. This article reviews the current evidence on Actovegin^®, its legal status with sports governing bodies and its potential role in sport injuries. We will also report our experience with this drug in treating muscle injuries. In this pilot study, players in the Actovegin treatment group were able to return to play 8 days earlier (95% CI −1.249 to −14.7510) compared to physiotherapy alone (p=0.033). No adverse reactions were recorded in any of the participants.

Key words

Actovegin - muscle injuries - doping

References

• 1 Abramson SB, Weissmann G. The mechanisms of action of nonsteroidal antiinflammatory drugs.  Arthritis Rheum. 1989;  32 1-9
• 2 Appiah AK. Treatment of severe primary postpartum hemorrhage with a deproteinized hemodialysate.  Int J Gynaecol Obste. 2002;  7 75-76
• 3 Askling C, Karlsson J, Thorstensson A. Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload.  Scand J Med Sci Sports. 2003;  13 244-250
• 4 Beetz A, Machicao F, Ried C, Ruzicka T, Michel G. Radioprotective effects of a protein-free hemodialysate in human epidermis.  Skin Pharmacol Physiol. 1996;  9 197-202
• 5 Bennell K, Wajswelner H, Lew P, Schall-Riaucour A, Leslie S, Plant D, Cirone J. Isokinetic strength testing does not predict hamstring injury in Australian Rules footballers.  Br J Sports Med. 1998;  32 309-314
• 6 Biland L, Hurlimann F, Goor W, Korner WF, Kundig A, Madar G, Widmer LK, Ziegler WJ. Treatment of venous ulcers a multi-center randomized double-blind study.  Vasa. 1985;  14 383-389
• 7 Boyarinov GA, Mukhina IV, Penknovich AA, Snopova LB, Zimin YV, Balandina MV, Radaev AM, Skvortsova IE, Prodanets NN. Effects of Actovegin on the central nervous system during postischemic period.  Bull Exp Biol Med. 1998;  126 993-996
• 8 Crompton S. The Most Feared Man in Football.  The Times 2006 June 2006; 
• 9 DRO Global database . http://www.globaldro.com Accessed September 2010; 
• 10 Derev’yannykh EA, Bel'skaya GN, Knoll EA, Krylova LG, Popov DV. Experience in the use of actovegin in the treatment of patients with cognitive disorders in the acute period of stroke.  Neurosci Behav Physiol. 2008;  38 873-875
• 11 Ekstrand J, Hagglund M, Walden M. Injury incidence and injury patterns in professional football – the UEFA injury study.  Br J Sports Med. 2009;  43 1036-1040
• 12 Harriss J, Atkinson G. International Journal of Sports Medicine – Ethical Standards in Sport and Exercise Science Research.  Int J Sports Med. 2009;  30 701-702
• 13 Jarvinen TA, Kaariainen M, Jarvinen M, Kalimo H. Muscle strain injuries.  Curr Opin Rheumatol. 2000;  12 155-161
• 14 Kasemkijwattana C, Menetrey J, Bosch P, Somogyi G, Moreland MS, Fu FH, Buranapanitkit B, Watkins SS, Huard J. Use of growth factors to improve muscle healing after strain injury.  Clin Orthop Relat Res. 2000;  370 272-285
• 15 Khomutov VA, Panteleev AV, Shchegolev AV, Kotov VI, Khomutov VA, Panteleev AV, Shchegolev AV, Kotov VI. [Prolonged regional intra-arterial therapy in multimodal treatment of patients with severe skeletal trauma].  Anesteziologiia i Reanimatologiia. 1999;  2 19-22
• 16 Maillo L. Anaphylactic shock with multiorgan failure in a cyclist after intravenous administration of Actovegin.  Ann Intern Med. 2008;  148 407
• 17 McCrory P, Franklyn-Miller A, Etherington J. Sports and exercise medicine – new specialists or snake oil salesmen?.  Br J Sports Med. 2009;  published online
• 18 Nycomed offical website information on Actovegin . http://www.nycomed.com.cn/english/wmdcp/awz/biaoti.html Accessed September 2010; 
• 19 Obremsky WT, Seaber AV, Ribbeck BM, Garrett Jr WE. Biomechanical and histologic assessment of a controlled muscle strain injury treated with piroxicam.  Am J Sports Med. 1994;  22 558-561
• 20 Orchard JW, Best TM, Mueller-Wohlfahrt HW, Hunter G, Hamilton BH, Webborn N, Jaques R, Kenneally D, Budgett R, Phillips N, Becker C, Glasgow P. The early management of muscle strains in the elite athlete: Best practice in a world with a limited evidence basis.  Br J Sports Med. 2008;  42 158-159
• 21 Pfister VA, Koller W. Therapie der frischen Muskelverletzung [Treatment of fresh muscle injury].  Sportverletz Sportschaden. 1990;  4 41-44
• 22 Pforringer W, Pfister A, Kuntz G. The treatment of Achilles paratendinitis: Results of a double-blind, placebo-controlled study with a deproteinized hemodialysate.  Clin J Sport Med. 1994;  4 92-99
• 23 Reynolds JF, Noakes TD, Schwellnus MP, Windt A, Bowerbank P. Non-steroidal anti-inflammatory drugs fail to enhance healing of acute hamstring injuries treated with physiotherapy.  S Afr Med J. 1995;  85 517-522
• 24 Schoenwald D, Sixt B, Machicao F, Marx E, Haedenkamp G, Bertsch S. Enhanced proliferation of coronary endothelial cells in response to growth factors is synergized by hemodialysate compounds in-vitro.  Res Exp Med. 1991;  191 259-272
• 25 Shen W, Li Y, Tang Y, Cummins J, Huard J. NS-398, a cyclooxygenase-2-specific inhibitor, delays skeletal muscle healing by decreasing regeneration and promoting fibrosis.  Am J Pathol. 2005;  167 1105-1117
• 26 Tsitsimpikou C, Tsiokanos A, Tsarouhas K, Schamasch P, Fitch KD, Valasiadis D, Jamurtas A. Medication use by athletes at the Athens 2004 Summer Olympic Games.  Clin J Sport Med. 2009;  19 33-38
• 27 Verrall GM, Slavotinek JP, Barnes PG, Fon GT, Spriggins AJ. Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging.  Br J Sports Med. 2001;  35 435-439
• 28 WADA . World Anit-Doping Agency Prohibited List.  http://www.wada-ama.org/en/prohibitedlist.ch2. Accessed September 2010; 
• 29 Woods C, Hawkins RD, Maltby S, Hulse M, Thomas A, Hodson A. Football Association Medical Research Programme. The Football Association Medical Research Programme: an audit of injuries in professional football – analysis of hamstring injuries.  Br J Sports Med. 2004;  38 36-41
• 30 Wright-Carpenter T, Klein P, Schferhoff P, Appell HJ, Mir LM, Wehling P. Treatment of muscle injuries by local administration of autologous conditioned serum: A pilot study on sportsmen with muscle strains.  Int J Sports Med. 2004;  25 588-593
• 31 Ziegler D, Movsesyan L, Mankovsky B, Gurieva I, Abylaiuly Z, Strokov I. Treatment of symptomatic polyneuropathy with Actovegin in type 2 diabetic patients.  Diabetes Care. 2009;  32 1479-1484

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