Could Drug Containing DHEA Be an Answer for Lupus?

June 23, 2000 -- As anyone who lives with lupus can tell you, it's sometimes hard to tell which is worse, the disease or the treatment. So any new therapy that might allow them to take less of their usual medications is likely to generate plenty of interest.

One new medication may hold promise. It combines two drugs: prasterone and DHEA, a common over-the-counter supplement. The medication may reduce the severity of several minor symptoms, but it also may decrease the level of HDL "good" cholesterol in the body, according to researchers who presented their findings at a meeting of metabolic specialists in Toronto.

People with lupus often have rashes that come and go, pain in the muscles and joints, and fatigue. Because the disease is caused by an overactive immune system, medications used to treat it, such as steroids, are meant to reduce the immune system's activity. The standby treatment for these patients is a steroid called prednisone, which is very different from the anabolic steroids used by bodybuilders.

Steroids, which also are used to treat conditions such as arthritis and asthma, are very effective, but long-term use can cause a host of problems, ranging from acne and bloating to osteoporosis.

Alice Baker, a Houston-based public relations specialist with lupus, explains the dilemma these patients face. "The muscle aches are so severe that I feel like my body is vibrating," she tells WebMD. But because the prednisone-related side effects are so severe, and because her lupus is not severe enough to cause damage to her kidneys or other organs, she takes prednisone only when her lupus flares up.

Susan Lobb of Denver is 53 years old and has had broken bones from prednisone. "Everyone with lupus wants a new medication," she tells WebMD. "Prednisone is a serious problem."

Doctors and patients are keeping a close eye on DHEA because it may help patients take lower doses of steroids and, they hope, decrease the side effects of prednisone. DHEA has long been known to suppress the immune system, researcher Robert Lahita, MD, PhD, tells WebMD. He is chief of rheumatology at St. Vincent's Hospital in New York City and professor of medicine at New York Medical College.

For the study, researchers looked at close to 400 women with mild to moderate lupus, who were given either the medication including DHEA or a placebo. They took DHEA in purer form and in significantly lower doses than the tablets commonly available in health food stores, which are typically 2,500 mg per pill, Lahita says.

The people who got the DHEA medication had less muscle pain, fewer mouth and nose ulcers, and less baldness than the placebo patients, but the good HDL cholesterol fell in these patients as well.

These results are short of a ringing endorsement, Carolyn Bowles, MD, tells WebMD in an interview. "These ... findings are not sufficiently motivating for me to use DHEA," says Bowles, a rheumatologist affiliated with the Park Nicollet Clinic in Minneapolis. These symptoms "aren't the main end points I'm looking at when I treat lupus patients." She also was concerned about the lowering of HDL cholesterol.

The drug, currently called GL701, is manufactured by Genelabs Technologies Inc., which participated in the study. Lahita has no financial interest in this company.