Patients with immunological disorders

In a number of studies DHEA supplementation has been used to modify immune functions and alter the course of immunopathies. Most studies have been performed in patients with systemic lupus erythematosus (SLE), a chronic autoimmune inflammatory disease of unknown etiology (Chang et al. 2002; Petri et al. 2002; Van Vollenhoven et al. 1995). The concept to use DHEA in the treatment of SLE was based on the observation that women are more often affected and that androgens and DHEA concentrations are low in patients with SLE (Lahita et al. 1987). Moreover, androgen treatment can modify the disease progression in an animal model of SLE (Melez et al. 1980). After preliminary evidence of a glucocorticoid-sparing effect of DHEA in patients with mild SLE (Van Vollenhoven et al. 1994) a randomized double-blind placebo-controlled trial was performed (200 mg DHEA orally for three months) (Van Vollenhoven et al. 1995). It demonstrated beneficial effects of DHEA on patient and physician overall assessment, SLE disease activity index (SLEDAI) and glucocorticoid requirements. This was confirmed in recent double-blind randomized, placebo-controlled trials demonstrating that DHEA (200 mg/day) was well tolerated, reduced the number of SLE flares, reduced disease activity and allowed reducing the dosage of glucocorticoids (Chang et al. 2002; Petri et al. 2002). It is important to note that these studies included women only and that it remains unclear whether similar results can be obtained in men. In a phase II uncontrolled pilot trial DHEA (200 mg/day) was effective and safe in patients with refractory Crohn's disease and ulcerative colitis (Andus et al. 2003). However, to date no placebo-controlled trials have been performed in inflammatory bowel disease. In all these trials side-effects were mild with acne being the most frequently seen adverse event despite the use of undoubtedly supraphysiological DHEA doses (200 mg/d).

DHEA supplementation has also been used to enhance the antibody response to tetanus and influenza vaccines (Danenberg etal. 1997; Degelau etal. 1997; Evans etal. 1996). However, in these randomized placebo-controlled trials no consistent effect of DHEA on protective antibody titers was found.

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