Why sarcopenia matters
Sarcopenia, the age-related decline in skeletal muscle mass and strength, has become a growing concern in ageing populations. The condition contributes significantly to frailty, falls, fractures, disability and even mortality, placing an increasing burden on healthcare systems. The National Institute on Aging defines sarcopenia as a progressive loss of muscle mass and function that impacts daily activities and independence. A 2023 review found that sarcopenia is linked to “a greater risk of polypharmacy and number of medications” in older adults, underlining its far-reaching implications for wellbeing and longevity.
While resistance training, protein-rich nutrition and adequate vitamin D intake remain essential strategies for prevention and management, many older adults find it difficult to achieve or sustain the physical activity levels required for meaningful improvement. This gap has fuelled growing interest in pharmacological approaches designed to preserve or restore muscle mass. According to a Frontiers in Physiology review, current drug research is focusing on anabolic signalling, anti-inflammatory pathways and mitochondrial function as key therapeutic targets.
Mechanistic targets under investigation
Drug developers are exploring a variety of biological mechanisms to counteract muscle loss and weakness.
One focus area is neuromuscular signalling. Scientists at the University of Missouri-Columbia have identified a serotonin receptor agonist (5-HT₂C) that enhances motor neuron excitability, allowing neurons to fire more efficiently and improve muscle contraction in animal models. This suggests that the decline in muscle strength during ageing may stem as much from impaired neuromuscular communication as from the physical loss of muscle fibres themselves.
Inflammation is another central target. Chronic, low-grade inflammation contributes to catabolic muscle breakdown in older adults. A review in Immunity & Ageing noted that non-steroidal anti-inflammatory drugs (NSAIDs) appeared to lower the risk of sarcopenia (odds ratio 0.26 after adjustment), while other immunomodulatory compounds such as rapamycin and spermidine are under investigation for their potential to stimulate autophagy and muscle renewal.
Hormonal regulation also plays a key role. Myostatin inhibitors, selective androgen receptor modulators (SARMs) and testosterone prodrugs are among the leading molecules being evaluated for anabolic effects on muscle tissue. Myostatin suppression, in particular, aims to remove a natural brake on muscle growth.
Current drug candidates and emerging therapies
Several pharmaceutical companies are now advancing dedicated therapies for sarcopenia, with a range of mechanisms and delivery systems under study.
One of the most advanced candidates is Isomyosamine (MYMD-1), developed by TNF Pharmaceuticals, Inc. The oral tumour necrosis factor (TNF-α) inhibitor demonstrated encouraging results in a Phase 2a study of adults aged 65 and over with chronic inflammation and sarcopenia or frailty. After 28 days of treatment, participants experienced statistically significant reductions in TNF-α (P = 0.008), interleukin-6 (P = 0.03) and soluble TNF receptor-1 (P = 0.02), with no serious adverse events. The compound is currently being evaluated in a Phase 2 clinical trial (NCT05133850) to further assess efficacy and safety. A larger Phase 2b trial is expected to commence in early 2025. TNF Pharmaceuticals has also announced plans to test MYMD-1 for muscle loss linked to rapid weight reduction in patients using GLP-1 receptor agonists, developed in partnership with Renova Health, Inc.
Another notable programme comes from Anodyne Nanotech, whose drug ANN-102 acts as an APJ-receptor agonist. Delivered via the company’s proprietary HeroPatch™ microneedle system, the treatment showed improved muscle strength in preclinical studies, matching the effects of daily injectable formulations. This transdermal technology may provide a convenient alternative for older adults or patients with mobility challenges.
In March 2025, Allosteric Bioscience, Inc. licensed novel sarcopenia-prevention technology from Johns Hopkins University. Developed by Dr Barbara Slusher’s team, the programme focuses on compounds that help prevent muscle loss both in natural ageing and in individuals experiencing muscle atrophy as a side effect of weight-loss medication. The agreement signals growing recognition of sarcopenia as a distinct and addressable disease category within drug development.
Market analysts report that more than 18 pharmaceutical companies are now pursuing sarcopenia-related pipelines, representing over 20 drug candidates. Among them are Epirium Bio Inc., developing MF-300, an oral 15-PGDH enzyme inhibitor, and Lipocine Inc., advancing LPCN1148, an oral testosterone prodrug with potential applications in muscle preservation.
Recent scientific highlights
Research activity in this field is accelerating. A University of Missouri team recently offered preclinical proof that boosting motor neuron firing pharmacologically can improve muscle strength, marking a new neuromuscular approach to sarcopenia treatment. Meanwhile, the rapid global uptake of GLP-1 agonists for weight loss has brought renewed urgency to the issue, as these drugs can lead to unwanted reductions in lean body mass. This has prompted parallel efforts to develop adjunct therapies to safeguard muscle health during weight loss.
Other studies have examined metabolic agents such as nicotinamide mononucleotide (NMN) and nicotinamide riboside (NR), both precursors in NAD⁺ metabolism. However, a 2025 meta-analysis found their effects on skeletal muscle index, handgrip strength and gait speed remain inconclusive. Market forecasts estimate that the global sarcopenia therapeutics sector could grow at an annual rate exceeding eight per cent, reaching several billion US dollars in value by 2034.
Challenges and caveats
Despite growing momentum, significant barriers remain before an approved anti-sarcopenia drug reaches patients.
Firstly, no pharmacological therapy has yet been approved by regulators specifically for sarcopenia. Although multiple compounds show promise in early trials, none have completed the rigorous late-phase studies required to confirm long-term efficacy and safety.
Secondly, the condition’s multifactorial nature poses a challenge for drug design. Sarcopenia arises from a complex interplay of inflammation, hormonal decline, neuromuscular degeneration, mitochondrial dysfunction and inactivity. Targeting one pathway may not yield sufficient benefit on its own.
A third limitation lies in the difficulty of measuring treatment success. Unlike diseases with clear biomarkers, sarcopenia trials rely on functional endpoints such as walking speed or grip strength, which require longer follow-up periods and larger sample sizes to establish statistically meaningful results.
Lifestyle factors also remain crucial. Pharmacotherapy is unlikely to replace the benefits of physical activity and nutritional optimisation. As Harvard Health emphasises, maintaining muscle mass with age still depends on regular resistance training and adequate protein intake. For many individuals, drug treatments will likely serve as adjuncts rather than stand-alone solutions.
Finally, safety must be carefully considered. Older adults often have multiple comorbidities and take several medications, increasing the risk of drug interactions. Agents that affect immune function or hormone levels require especially careful evaluation in frail populations.
What this means for patients and clinicians
Clinicians may soon have access to the first targeted pharmacological options for sarcopenia, potentially offering new hope to patients unable to exercise sufficiently due to frailty or chronic illness. Early detection and routine screening for muscle weakness should be prioritised, using simple tools such as handgrip tests or gait-speed assessments.
In addition to lifestyle measures, healthcare providers prescribing GLP-1 weight-loss drugs should monitor patients for signs of muscle depletion and consider integrating supportive interventions.
Ultimately, these drugs aim to complement not replace exercise and nutrition. The most effective future strategies are expected to combine pharmacotherapy, physical activity and dietary optimisation into a comprehensive management plan.
As the world’s population ages, the need for therapies that preserve mobility and independence becomes increasingly urgent. The World Health Organization notes that maintaining muscle health is vital to reducing disability, promoting healthy ageing and lessening the economic burden of chronic disease. The current wave of pharmaceutical research reflects growing recognition of this reality.
The next few years could prove pivotal. Should ongoing trials confirm the benefits of agents such as MYMD-1, ANN-102 or other myostatin inhibitors, sarcopenia could become one of the first geriatric conditions with a dedicated drug therapy. Until then, experts stress the importance of prevention and holistic care. As one researcher put it, “We are not trying to replace exercise, but to find something that makes it more feasible and more effective.”
