Rf. Van Vollenhoven et al., A double-blind, placebo-controlled, clinical trial of dehydroepiandrosterone in severe systemic lupus erythematosus, LUPUS, 8(3), 1999, pp. 181-187
Objective: To determine if dehydroepiandrosterone (DHEA) is beneficial in s
evere systemic lupus erythematosus (SLE).
Methods: A double-blinded, placebo-controlled, randomized clinical trial in
21 patients with severe and active SLE, manifestated primarily by nephriti
s, serositis or hematological abnormalities. In addition to conventional tr
eatment with corticosteroids +/- immunosuppressives, patients received DHEA
200 mg/d vs placebo for 6 months, followed by a 6-month open label period.
The primary outcome was a prospectively defined responder analysis, based
on a quantitatively specified improvement of the principal severe lupus man
ifestation at 6 months.
Results: Nineteen patients were available for evaluation at 6 months. Basel
ine imbalance between the groups was noted, with the DHEA group having grea
ter disease activity at baseline (P < 0.05 by physician's global assessment
). Eleven patients were responders: 7/9 patients on DHEA vs 4/10 patients o
n placebo (P < 0.10). Of the secondary outcomes, mean improvement in SLE di
sease activity index (SLE-DAI) score was greater in the DHEA group (-10.3+/
-3.1 vs -3.9 +/- 1.4, P < 0.07). Bone mineral density at the lumbo-sacral s
pine showed significant reduction in the placebo group, but was maintained
in the DHEA group.
Conclusion: DHEA therapy, when added to conventional treatment for severe S
LE, may at most have a small added benefit with respect to lupus outcomes,
but baseline imbalances in the study population limit the generalizability
of the results. DHEA appears to have a protective effect with respect to co
rticosteroid-induced osteopenia in such patients.