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July 24, 2002 — Prasterone (dehydroepiandrosterone
[DHEA]), 200 mg daily, allowed reduced dosing of prednisone for
women with systemic lupus erythematosus (SLE) in a double-blind,
placebo-controlled trial reported in the July issue of Arthritis
& Rheumatism.
"Among women with lupus disease activity, reducing
the dosage of prednisone to
Petri's group randomized 191 female SLE patients receiving
prednisone (10-30 mg/day) to daily treatment with either placebo,
100 mg of oral prasterone, or 200 mg of oral prasterone for seven
to nine months. Patients in whom SLE Disease Activity Index score
was stable or improved had reductions in corticosteroid dosages
by algorithm at monthly intervals. Positive response was defined
as a sustained reduction in the dosage of prednisone (
Response rates were 41% in the placebo group, 44%
in the 100-mg prasterone group, and 55% in the 200-mg prasterone
group (P=.110 for 200 mg vs. placebo). Considering only those 137
subjects with active disease at baseline, response rates were 29%
in the placebo group, 38% in the 100-mg group, and 51% in the 200-mg
group (P=.031 for 200 mg vs. placebo).
"Acne was the most common adverse event but was
generally mild," the authors write. "Clinical and laboratory changes
primarily reflected androgenic effects of prasterone."
The authors caution against extrapolating the findings
to men, and they recommend long-term studies in both sexes to further
evaluate possible cardiovascular effects of prasterone and to determine
whether steroid reduction can be maintained.
"Prasterone has corticosteroid-sparing effects in
SLE, especially among patients with active disease," the authors
write. "Patients with SLE who are maintained for long periods of
time on supraphysiologic doses of glucocorticoids may benefit from
controlled tapering of glucocorticoids to physiologic doses, with
consequent reduction of glucocorticoid toxicity, during treatment
with prasterone."
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