Treatment of Autoimmune Diseases
The potential value of DHEA as a treatment for autoimmune disease was suggested by the observation that DHEA reduced the severity of renal damage in the NZB x NZW mouse, an animal model of spontaneous lupus. A clinical trial was therefore performed with ten women suffering from mild or moderate systemic lupus erythematosus (SLE).20 Each patient received 200 mg per day of DHEA for 3 to 6 months. Eight of the 10 patients reported improvements in overall well-being, fatigue, energy, and/or other symptoms. For the group as a whole there was significant improvement in the physician’s overall assessment of disease activity. After 3 months, the average prednisone requirement had decreased from 14.5 to 9.4 mg per day. Of three patients with significant proteinuria, two showed marked reductions and one a modest reduction in protein excretion. There was no significant correlation between changes in serum DHEA or
DHEA-S levels and clinical response. In addition, pre-treatment levels of these hormones
did not predict clinical response. Side effects were limited to mild or moderate acneiform
dermatitis and mild hirsutism.
Administration of relatively large doses of DHEA has also been reported to increase stamina and improve the sense of well-being in patients with multiple sclerosis.21
During the past 5 years, a number of practitioners have been prescribing DHEA for patients with autoimmune disease. Pre-treatment plasma levels of DHEA or DHEA-S are usually below normal in patients receiving prednisone or related drugs, because these medications cause adrenal suppression. However, in my experience, DHEA-S levels are also frequently low in patients with autoimmune disease who are not receiving corticosteroids.
I have treated a 76-year-old female patient with rheumatoid arthritis who was being maintained on 5 mg per day of prednisone. After taking 10 mg per day of DHEA for several weeks, her joint symptoms improved and she was able to wean off the prednisone. Another woman with poorly controlled dermatomyositis had marked clinical improvement and was able to reduce her prednisone by 50% after receiving 10 mg of DHEA, twice a day. A female patient with a 3-year history of persistent bleeding due to inflammatory bowel disease reported no further bleeding after taking 15 mg per day of DHEA. Two other women with SLE had clinical improvements with DHEA. However, low doses were not effective in these cases; results became apparent only after the dose was increased to around 100 mg per day or more.
Lamson has given DHEA to six patients with ulcerative colitis that had failed to respond to a combination of conventional therapy and nutritional treatments. In all six cases, the bleeding, diarrhea, and overall condition improved.22
Some patients with chronic fatigue syndrome (CFS) have also improved clinically
with DHEA therapy. However, since cortisol deficiency appears to be the primary problem in some patients with CFS and, since DHEA can antagonize the effects of cortisol, DHEA therapy might actually cause some patients with CFS to worsen. It is important, therefore, to measure both DHEA and cortisol levels before treating CFS patients with DHEA.
Acquired Immunodeficiency Syndrome
Preliminary evidence suggests that DHEA might play a role in acquired immunodeficiency syndrome (AIDS). In one study, DHEA inhibited the replication of HIV, the virus believed to cause AIDS.23 In addition, DHEA has been shown to enhance the immune response to viral infections. Furthermore, DHEA levels are low in people infected with HIV and these levels decline even more as the disease progresses to full-blown AIDS.24 In a study of 108 HIV-infected men with marginally low helper T-cell counts (between 200 and 499), those with serum DHEA levels below normal were 2.34 times more likely to progress to AIDS than were men with normal DHEA levels.25 These studies suggest that DHEA deficiency might be one of the factors contributing to immune system failure in HIV-infected patients.
To date, only one clinical trial has tested the effect of giving DHEA to HIV-infected patients. Although DHEA did not improve CD4 counts or serum p24 antigen levels,26 the dosage used (750-2,250 mg per day) seems excessively large, possibly beyond the “therapeutic window” in which DHEA exerts its beneficial effects. The concept of a therapeutic window clearly has been demonstrated for cortisol (the other major adrenal steroid). For example, cortisol is known to enhance immune function at physiologic levels. However, both a deficiency and an excess of cortisol result in impaired immune function. Future trials of DHEA in HIV-infected patients should therefore use lower doses, perhaps 50-200 mg/day.
