Effects of Prasterone (dehydroepiandrosterone) on markers of cardiovascular risk and bone turnover in premenopausal women with systemic lupus erythematosus: a pilot study

Marder, Wendy; Somers, Emily C.; Kaplan, Mariana J.; Anderson, Marie A.; Lewis, Edith A.; McCune, W. Joseph

doi:10.1177/0961203310371156

Cited by 19 publications

(9 citation statements)

References 49 publications

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“…Patients’ beliefs that they received DHEA, rather than their actual use of DHEA, was associated with reduced fatigue. Although DHEA supplementation shows some promise, there are also reports of frequent but mild side effects such as acne (in up to 54 % of patients) [48] and hirsuitism, as well as reports of reduction in HDL cholesterol [49]. …”

Section: Review Of Cam Treatments For Slementioning

confidence: 99%

Updated Review of Complementary and Alternative Medicine Treatments for Systemic Lupus Erythematosus

2013

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It is estimated that over 50 % of patients with systemic lupus erythematosus (SLE) have utilized complementary and alternative medicine (CAM) treatments to reduce symptoms and manage their health. However, there are relatively few randomized controlled trials of CAM for SLE. This review describes recent studies of vitamins and supplements, acupuncture, and mind-body interventions in SLE patients. The recent trials of CAM treatments for SLE indicate that supplements such as vitamin D, omega 3 fatty acids, N-acetyl cysteine and turmeric show some promise for reducing SLE disease activity. In addition, mind-body methods such as cognitive-behavioral therapy and other counseling interventions may improve mood and quality of life in SLE.

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Section: Review Of Cam Treatments For Slementioning

confidence: 99%

Updated Review of Complementary and Alternative Medicine Treatments for Systemic Lupus Erythematosus

2013

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“…It should however be noted that other investigators have been unable to replicate the findings of Kawano et al, and Williams et al, In studies of 12-26 weeks with 50 mg of DHEA administered to individuals with hypoadrenalism, Rice et al, [19] and Christiansen et al, [20] could not demonstrate an improvement in endothelial function or indices of arterial stiffness despite normalization of androgen levels. Likewise, Marder et al, found no improvement in vascular endothelial function in patients with systemic lupus erythematosus (SLE) treated with 200 mg daily of DHEA for 12 weeks [21]. One of the reasons for these discrepancies may reside in the concomitant use of glucocorticoids in patients with hypoadrenalism [19,20] and in 5/8 patients with SLE [21], since glucocorticoids may be antagonistic to DHEA [34].…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, Marder et al, found no improvement in vascular endothelial function in patients with systemic lupus erythematosus (SLE) treated with 200 mg daily of DHEA for 12 weeks [21]. One of the reasons for these discrepancies may reside in the concomitant use of glucocorticoids in patients with hypoadrenalism [19,20] and in 5/8 patients with SLE [21], since glucocorticoids may be antagonistic to DHEA [34].…”

Section: Discussionmentioning

confidence: 99%

“…Consistent with those data, daily administration of DHEA for 3 months to healthy postmenopausal women or to men with hypercholesterolemia increases endothelial dependent vasodilator function [17,18]. However, other long term studies of DHEA administration in humans have failed to demonstrate changes in vascular function [19][20][21]. We do not yet understand why the outcomes of these human studies differ from each other, or from animal and in vitro studies.…”

Section: Introductionmentioning

confidence: 87%

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Effect of dehydroepiandrosterone (DHEA) on vascular function in postmenopausal women with diabetes: a randomized controlled trial

Shibli-Rahhal¹,

Haynes²,

Sinkey³

et al. 2012

J Diab Res Clin Met

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Background: DHEA stimulates endothelial nitric oxide (NO) production in vitro and its prolonged use in humans improves vascular function. It is believed that this effect is mediated by metabolism of DHEA to androgens and estrogens. We hypothesized that DHEA action is mediated by a rapid, receptor-dependent, endothelial NO production pathway. We tested this hypothesis by studying the acute effect of a single oral dose of DHEA on vascular function in postmenopausal diabetic women. Design and Methods: This was a double blind, randomized, placebo controlled, cross-over study. Nine postmenopausal women with type 2 diabetes and 5 age-and weight-matched controls received 50 mg of DHEA or placebo in a random order one week apart. We examined forearm resistance vessel responses to intra-arterial nitroprusside, acetylcholine and verapamil. Results: There was no difference in baseline characteristics and steroid hormone levels between the groups. Following administration of DHEA, steroid hormone concentrations increased in both diabetics and controls indicating adequate absorption and metabolism of DHEA. Prior to administration of arterial vasodilators, there was no difference in baseline forearm blood flow between diabetics and controls and within each group in response to DHEA versus placebo. There was also no difference in the vasodilator-induced increment in blood flow between diabetics and controls and within each group in response to DHEA versus placebo. Conclusions: In postmenopausal women with diabetes, DHEA did not have any acute effect on basal or vasodilator stimulated forearm blood flow, despite evidence of systemic absorption and adequate vascular responses to endothelium and non-endothelium dependent vasodilators.

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“…One trial demonstrated that prasterone provided mild protection against bone loss in female SLE patients on chronic steroids [48]. However, in the premenopausal population, other trials have shown no effect on BMD and even potentially worsening of lipid profile with decreased HDL levels [49,50].…”

Section: Pharmacologic Treatmentmentioning

confidence: 99%

Prevention and Treatment of Bone Disease in Systemic Lupus Erythematosus

Lin

Grossman

2016

Curr Treat Options in Rheum

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Opinion statementSystemic lupus erythematosus (SLE), an autoimmune chronic inflammatory disease, can be associated with significant morbidity and mortality of which bone disease such as osteoporosis is a contributor. Patients with SLE are at risk for low bone mineral density (BMD) due to a variety of reasons including inflammation, glucocorticoid use, vitamin D deficiency, premature ovarian failure, increased damage, and traditional risk factors such as age and gender. With better treatments for SLE, survival has improved; therefore, complications from morbidity including osteoporosis need better prevention and treatment strategies. In SLE patients with osteoporosis or those on glucocorticoids who meet guidelines for therapeutic intervention, we prefer bisphosphonates as first-line therapy for most patients. They have proven efficacy in increasing BMD and decreasing fracture risk, known safety profiles, and have a favorable cost-effectiveness profile. The newer agents, teriparatide and denosumab, have not only demonstrated improvement in BMD but also decreased risk of fracture. We typically recommend these medications for some high-risk populations, those who have failed bisphosphonate therapy or those who are intolerant of oral bisphosphonates. Estrogen-containing drugs are not recommended for first-line prevention and treatment of osteoporosis given the elevated risk of cardiovascular disease. Calcitonin has also been used in osteoporosis; however, the bisphosphonates and newer drugs have proven to be more efficacious. Supplementation with calcium and vitamin D is recommended in particular with those patients who are vitamin D deficient and those on glucocorticoids, although data documenting fracture prevention with this strategy is limited. Therapeutic strategies for premenopausal women of child-bearing potential remain controversial because of limited data about safety in subsequent pregnancies. Decisions for these patients need to be made on a case by case basis weighing the risks and benefits to the individual patient. Future therapies targeting different mechanisms within bone resorption and formation are currently under investigation and will significantly add to our limited armamentarium.

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Effects of Prasterone (dehydroepiandrosterone) on markers of cardiovascular risk and bone turnover in premenopausal women with systemic lupus erythematosus: a pilot study

Cited by 19 publications

References 49 publications

Updated Review of Complementary and Alternative Medicine Treatments for Systemic Lupus Erythematosus

Updated Review of Complementary and Alternative Medicine Treatments for Systemic Lupus Erythematosus

Effect of dehydroepiandrosterone (DHEA) on vascular function in postmenopausal women with diabetes: a randomized controlled trial

Prevention and Treatment of Bone Disease in Systemic Lupus Erythematosus

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