Dehydroepiandrosterone in systemic lupus erythematosus: Relationship between dosage, serum levels, and clinical response

Objective, To examine in women with systemic lupus eythematosus (SLE) who p articipated in a clinical trial the relationship between daily dose of dehy droepiandrosterone (DHEA), serum levels of DHEA and DHEA sulfate (DHEAS), c linical effectiveness, and side effects, Methods. Twenty-three women with mild to moderate SLE were treated with DHE A for a 6 month period. The starting dose was 50 mg/day, and monthly stepwi se increases were allowed. Subjects were assessed monthly by the Systemic L upus Erythematosus Disease Activity Index, Systemic Lupus Activity Measure (SLAM), Health Assessment Questionnaire, and other outcomes. Serum testoste rone, DHEA, and DHEAS levels were obtained and side effects noted monthly, Results. Statistically significant improvements were found in all lupus out comes over 6 months. Serum DHEA and DHEAS levels correlated with the dose o f DHEA. Serum DHEA and DHEAS correlated negatively with SLAM score. A secon d order regression analysis of serum DHEAS level versus SLAM score suggeste d that the optimal serum level of DHEAS was 1000 mu g/dl. The most common s ide effect was acne. Conclusion, The clinical response to DHEA was not clearly dose dependent. S erum levels of DHEA and DHEAS correlated only weakly with lupus outcomes, b ut suggested an optimum serum DHEAS of 1000 mu g/dl. Monitoring these serum levels appears to have limited clinical utility.