Functional and body composition outcomes of pharmacological interventions for sarcopenia in older adults: A systematic review and pairwise meta-analysis of randomized controlled trials.

Background

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Aims

Pharmacological trials in sarcopenia have reported changes in muscle mass or selected functional measures, but the consistency and clinical importance of these effects remain uncertain. We conducted a systematic review and pairwise meta-analysis of randomized controlled trials (RCTs) in adults aged ≥65 years.

Methods

The original review search used MEDLINE and Embase from inception to 9 February 2026. CLINICALTRIALS gov was checked immediately after completion of the systematic review. Interventions were analyzed within four broad therapeutic Groups and complementary pharmacological Classes. Random-effects pairwise meta-analyses used mean differences (MDs) for functional outcomes and Hedges' g standardized mean differences (SMDs) for body-composition outcomes.

Results

Twenty-six RCTs including 3237 participants were included. At the Group level, Hormonal and anabolic therapies showed small pooled differences in grip strength (MD 1.003 kg, 95% CI 0.007 to 2.000) and 6-minute walk distance (MD 12.335 m, 95% CI 5.043 to 19.627). Myostatin inhibitors showed a gait-speed difference of 0.0300 m/s (95% CI 0.0295 to 0.0305) and a single-study estimate for appendicular lean body mass (SMD 0.573, 95% CI 0.291 to 0.855). The functional differences were below commonly cited meaningful-change benchmarks. Class-level evidence was sparse, with several Classes represented by one trial. Functional estimates for RAAS-based and Metabolic therapies were based on few trials and varied across outcomes.

Conclusion

Functional and body-composition estimates varied across therapeutic Groups and Classes. The observed functional differences were small relative to commonly cited benchmarks, and Class-level evidence was sparse. Future trials should prioritize durable mobility, independence, and safety outcomes.