Other Drugs for Lupus
In addition to these commonly used classes of medications, there are a number of other medications used, often experimentally, to treat lupus. These include thalidomide and dehydroepiandrosterone (DHEA).
Thalidomide is a notorious sleep aid that was pulled from the market in European countries when people discovered it caused birth defects. However, it is showing effectiveness as a treatment for skin manifestations of lupus. Although its precise mechanism is not clear, thalidomide inhibits inflammatory cytokines in the skin and underlying blood vessels. Thalidomide carries the risk of many side effects, including abdominal pain, infection, chills, diarrhea, liver abnormalities, anemia, peripheral edema, hyperlipidemia, leukopenia, insomnia, sensory neuropathy, albuminuria, hematuria, ovarian failure, and thrombosis. Because of the risk of birth defects, it is strictly contraindicated in women who are pregnant or might become pregnant. Scientists are working on developing a safer version of thalidomide. A number of other drugs are used to treat specific manifestations of lupus.
DHEA is a weak male hormone used by the body to make other hormones, including testosterone and estrogen. It appears to benefit women with lupus by helping to restore the balance of male-female hormones. The manufacturer of the DHEA product Prestara® recently completed a phase III clinical trial to determine if DHEA improves bone mineral density in women with lupus who are receiving corticosteroid therapy. There was a modest change at 1 year. An earlier study of the drug confirmed Prestara®’s ability to improve or stabilize clinical outcome and disease symptoms in women with mild-to-moderate lupus. The FDA did not approve DHEA for treating lupus. In the meantime, patients may get DHEA from a compounding pharmacist. If you have patients using DHEA, it is important to stress that they purchase a medical-grade product from a pharmacy and have regular check-ups to monitor response to the drug. DHEA is never used in men with lupus. In postmenopausal women, mammograms and PAP smears must be monitored.