Dehydroepiandrosterone in systemic lupus erythematosus: relationship between dosage, serum levels, and clinical response.
OBJECTIVE
To examine in women with systemic lupus erythematosus (SLE) who participated in a clinical trial the relationship between daily dose of dehydroepiandrosterone (DHEA), serum levels of DHEA and DHEA sulfate (DHEAS), clinical effectiveness, and side effects.


METHODS
Twenty-three women with mild to moderate SLE were treated with DHEA for a 6 month period. The starting dose was 50 mg/day, and monthly stepwise increases were allowed. Subjects were assessed monthly by the Systemic Lupus Erythematosus Disease Activity Index, Systemic Lupus Activity Measure (SLAM), Health Assessment Questionnaire, and other outcomes. Serum testosterone, DHEA, and DHEAS levels were obtained and side effects noted monthly.


RESULTS
Statistically significant improvements were found in all lupus outcomes over 6 months. Serum DHEA and DHEAS levels correlated with the dose of DHEA. Serum DHEA and DHEAS correlated negatively with SLAM score. A second order regression analysis of serum DHEAS level versus SLAM score suggested that the optimal serum level of DHEAS was 1000 microg/dl. The most common side effect was acne.


CONCLUSIONS
The clinical response to DHEA was not clearly dose dependent. Serum levels of DHEA and DHEAS correlated only weakly with lupus outcomes, but suggested an optimum serum DHEAS of 1000 microg/dl. Monitoring these serum levels appears to have limited clinical utility.
Barry
N N
NN
Division of Immunology and Rheumatology, Stanford University Medical Center, CA 94305-5111, USA.
McGuire
J L
JL
van Vollenhoven
R F
RF
D000152:Acne Vulgaris / Q000139:chemically induced; D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003687:Dehydroepiandrosterone / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000188:drug therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000276:Adjuvants, Immunologic; D003687:Dehydroepiandrosterone; D019314:Dehydroepiandrosterone Sulfate