Systemic Lupus Erythematosus - Treatment for Severe SLE

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The most frequent side effects of immunosuppressants include:

• Stomach and intestinal problems
• Skin rash
• Mouth sores
• Hair loss

Serious side effects of immunosuppressants include:

• Low blood cell counts
• Anemia
• Menstrual irregularity
• Early menopause
• Ovarian failure
• Infertility
• Herpes zoster (shingles)
• Liver and bladder toxicity
• Increased risk of cancer

A 2005 study suggested that short-term hormone replacement therapy is safe for women with SLE and does not increase the risk of disease flares. Sterility in female patients may be avoided by administering pulsed doses at the time of menstruation. In general, immunosuppressants should not be used alone unless corticosteroids are ineffective or inappropriate. Grapefruit juice has an enzyme that may enhance the effects of some immunosuppressants

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Hormone Treatments

Dehydroepiandrosterone (DHEA). Dehydroepiandrosterone (DHEA) is a natural steroid hormone that is produced by the adrenal glands and converted into estrogen and androgen. Some evidence suggests that DHEA deficiencies may play a role in SLE. Although DHEA is sold as a dietary supplement, and has been proclaimed as a cure for a wide variety of ailments, there is little scientific evidence to support most of these claims. In addition, because natural supplements are unregulated, there is no guarantee of quality control.

However, the synthetic equivalent of DHEA, prasterone, is being investigated as a potential treatment for SLE, and several clinical trials have indicated promising, although mixed, results. In a 2004 randomized, double-blind, placebo-controlled trial of women with active lupus, prasterone significantly improved or stabilized lupus symptoms and reduced disease flare-ups. Women who received prasterone also experienced reductions in total cholesterol and triglyceride levels. A 2005 trial of women with SLE found that prasterone prevented bone loss and increased spinal and hip BMD, but additional trials have failed to confirm the benefit. Women in both trials were also taking other SLE drug treatments, such as prednisone. Prasterone is still in the drug development stage and it is not clear when, or if, it will be commercially available.