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Evidence summaries

Dehydroepiandrosterone (Dhea) for Systemic Lupus Erythematosus (Sle)

Dehydroepiandrosterone compared to placebo might possibly have limited or no effect on disease activity with mild to moderate systemic lupus erythematosus, but it may slightly improve health-related quality of life. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 7 studies (lasting 3-12 months) with a total of 842 subjects. Impact on disease activity was inconsistent. Meta-analysis was possible for two studies with mild/moderate disease (N = 148) and supported no statistically significant mean difference in systemic lupus erythematosus (SLE) disease activity index (SLEDAI) among those treated with dehydroepiandrosterone (DHEA) versus placebo (WMD -0.6, 95% CI -2.12 to 0.89). Three of the studies that could not be included in the meta-analysis reported findings in keeping with the meta-analysis result. One study reported, that if only those with 'active' disease (SLEDAI > 2) were included in the analysis, 8.3% (P = 0.04) more people remain "stable or improve" on DHEA versus placebo, measured using SLEDAI. One very small trial (n=19) in participants with severe SLE reported improvements in SLEDAI among those treated with DHEA that were of borderline statistical significance when compared with placebo.

DHEA compared to placebo had a modest but clinically significant improvement in health related quality of life measured by Patient Global Assessment, estimated as 11.5% (reduction of 11.5 mm on a 100 mm scale, 95% CI -19.08 to -3.84; 2 studies, n=148). The Physicians global score was reported in three studies; in none of the studies was a statistically significant improvement achieved. DHEA resulted in a greater number of patients experiencing adverse events (RR 2.2, 95% CI 1.65 to 2.83), particularly androgenic effects such as acne. Due to the small study size and short follow-up time it was not possible to study whether DHEA causes long term side effects such as heart problems or cancer.

Comment: The quality of evidence in downgraded by study quality (unclear allocation concealment), by inconsistency (variability in results across studies) and by imprecise results (limited study size for each comparison). Long-term outcomes and safety remain unstudied.

    References

    • Crosbie D, Black C, McIntyre L, Royle PL, Thomas S. Dehydroepiandrosterone for systemic lupus erythematosus. Cochrane Database Syst Rev 2007 Oct 17;(4):CD005114. [PubMed]

Primary/Secondary Keywords