Seminars in Arthritis and Rheumatism
Volume 40, Issue 4 , Pages 298-306 , February 2011

Danazol in the Treatment of Systemic Lupus Erythematosus: A Qualitative Systematic Review

  • Pagalavan Letchumanan, MRCP(UK)

      Affiliations

    • School of Medicine and Health Sciences, Monash University (Sunway Campus), Johor Bahru, Malaysia
    • Corresponding Author InformationAddress reprint requests to Pagalavan Letchumanan, MRCP(UK), School of Medicine and Health Sciences, Monash University (Sunway Campus), JKR 1235, Bukit Azah, 80100 Johor Bahru, Malaysia
  • ,
  • Julian Thumboo, FRCP(Edin)

      Affiliations

    • Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
    • Duke–NUS Graduate Medical School and the Yong Loo Lin School of Medicine, National University of Singapore, Singapore

References 

  1. Hughes GRV, Ryan PFJ. Systemic lupus erythematosus—some aspects of management. Aust NZ J Med. 1981;11:545–549
  2. Agnello V, Pariser K, Gell J, Gelfand J, Turksoy RN. Preliminary observations on danazol therapy of systemic lupus erythematosus: effects on DNA antibodies, thrombocytopenia and complement. J Rheumatol. 1983;10:682–689
  3. Madanes AE, Farber M. Danazol. Ann Intern Med. 1982;96:625–630
  4. Spooner SB. Classification of side-effects of danazol therapy. J Intern Med Res. 1977;5(Suppl 3):15
  5. Schreiber AD, Chin P, Tomaski A, Cines DB. Effects of danazol in immune thrombocytopenic purpura. N Engl J Med. 1987;316:503–508
  6. Mylvaganam R, Ahn YS, Harriongton W, Kim CI. Immune modulation by danazol in autoimmune tombocytopenia. Clin Immunol Immunpathol. 1987;42:281–287
  7. Ahn YS, Fernandez LF, Kim CI, Mylvaganam R, Temple JD, Cayer ML, et al. Danazol therapy renders red cells resistant to osmotic lysis. FASEB J. 1989;3:157–162
  8. Lahita RG, Bradlow HL, Kunkel HG, Fishman J. Alterations of estrogen metabolism in systemic lupus erythematosus. Arthritis Rheum. 1979;22:1195–1199
  9. Arnalich F, Benito-Urbina S, Gonzalez-Gancedo P, Iglesias E, de Miguel E, Gijon-Banos J. Inadequate production of progesterone in women with systemic lupus erythematosus. Br J Rheumatol. 1992;31:247–251
  10. Jungers P, Nahoul K, Pelissier C, Dougadoss M, Tron FL, Bach JF. Low plasma androgens in women with active or quiescent systemic lupus erythematosus. Arthritis Rheum. 1982;25:454–460
  11. Carlsten H, Tarkowski A. Histocompatibility complex gene products and exposure to estrogen: two independent disease accelerating factors in murine lupus. Scand J Immunol. 1993;38:341–347
  12. Duvic M, Steinberg AD, Klassen LW. Effects of the anti-estrogen, nafoxidine on NZB/W autoimmune disease. Arthrtis Rheum. 1978;21:414–417
  13. Roubinian JR, Talal N, Greenspan JS, Goodman JR, Siiteri PK. Effects of castration and sex hormone treatment on survival, anti-nucleic acid antibodies and glomerulonephritis in NZB X NZW F1 mice. J Exp Med. 1978;147:1568–1583
  14. Roubinian JR, Papoian R, Talal N. Androgenic hormones modulate autoantibody responses and improve survival in murine lupus. J Clin Invest. 1977;59:1066–1070
  15. Blank M, Mendlovic S, Fricke H, Mozes E, Talal N, Shoenfeld Y. Sex hormone involvement in the induction of experimental systemic lupus erythematosus by a pathogenic anti-DNA idiotype in naïve mice. J Rheumatol. 1990;17:311–317
  16. Sequeira JF, Keser G, Greenstein B, Wheeler MJ, Duarte PC, Khamashta MA, et al. Systemic lupus erythematosus: sex hormones in male patients. Lupus. 1993;2:315–317
  17. Mok CC, Lau CS. Profile of sex hormones in male patients with systemic lupus erythematosus. Lupus. 2000;9:252–257
  18. Stern R, Fishman J, Brusman H, Kunkel HG. Systemic lupus erythematosus associated with Klinefelter's syndrome. Arthritis Rheum. 1977;20:18–22
  19. Michalski JP, Snyder SM, Mcleod RL, Talal N. Monozygotic twins with Klinefelter's syndrome discordant for systemic lupus erythematosus and symptomatic myasthenia gravis. Arthritis Rheum. 1978;21:306–309
  20. French MA, Hughes P. Systemic lupus erythematosus and Klinefelter's syndrome. Ann Rheum Dis. 1983;42:471–473
  21. Bizzarro A, Valentini G, Martino GD, Daponte A, De Bellis A, Iacono G. Influence of testosterone therapy on clinical and immunological features of autoimmune diseases associated with Klinefelter's syndrome. J Clin Endocrinol Metab. 1987;64:32–36
  22. Olsen NJ, Kovacs WJ. Case report: testosterone treatment of systemic lupus erythematosus in a patient with Klinefelter's syndrome. Am J Med Sci. 1995;310:158–160
  23. Haris E, Budd R, Firestein G, Genovese M. Kelley's Textbook of Rheumatology. 7th ed.. Philadelphia: Saunders; 2004;
  24. Isenberg D, Maddison P, Woo P, Glass D, Breedreld F. Oxford Textbook of Rheumatology, 3rd ed. New York: Oxford University Press; 2004;
  25. Arnal C, Piette JC, Leone J, Taillan B, Hachulla E, Roudot-Thoraval F, et al. Treatment of severe immune thrombocytopenia associated with systemic lupus erythematosus: 59 cases. J Rheumatol. 2002;29:75–83
  26. Cervera H, Jara LJ, Pizarro S, Enkerlin HL, Fernandez M, Medina F, et al. Danazol for systemic lupus erythematosus with refractory autoimmune thrombocytopenia or Evan's syndrome. J Rheumatol. 1995;22(10):1867–1871
  27. Dougadoss M, Amor B, Job-Deslandre C, Menkes CJ. Danazol in systemic lupus erythematosus: a two year prospective controlled trial in forty female patients (abstract). Arthritis Rheum. 1985;28:S46
  28. Marino C, Cook P. Danazol for lupus thrombocytopenia. Arch Intern Med. 1985;145:2251–2252
  29. West SG, Johnson SC. Danazol for the treatment of refractory autoimmune thrombocytopenia in systemic lupus erythematosus. Ann Intern Med. 1988;108:703–706
  30. Juby A, Davis P. Recurrent autoimmune thrombocytopenia in a patient with systemic lupus erythematosus: treatment with repeated splenectomy!. J Rheumtol. 1989;16(10):1362–1363
  31. Wong KL. Danazol in treatment of lupus thrombocytopenia. Asian Pac J Allergy Immunol. 1991;9:125–129
  32. Insiripong S, Chanchairujira T, Bumpenboon T. Danazol for thrombocytopenia in pregnancy with underlying systemic lupus erythematosus. J Med Assoc Thailand. 1996;79:330–332
  33. Blanco R, Martinez-Taboada M, Rodriguez-Valverde V, Sanchez-Andrade A, Gonzalez-Gay A. Successful therapy with danazol in refractory autoimmune thrombocytopenia associated with rheumatic diseases. Br J Rheumatol. 1997;36:1095–1099
  34. Marwaha V, Kumar A, Grover R, Tiwari S, Chaudhary VP. Systemic lupus erythematosus and refractory cytopenia: successful outcome with danazol. National Med J India. 2004;17:54–55
  35. Aranegui P, Giner P, Lopez-Gomez M, el Amrani A, Jimenez-Alonso J. Danazol for Evan's syndrome due to SLE. DICP. 1990;24(6):641–642
  36. Chan AC, Sack K. Danazol therapy in autoimmune hemolytic anemia associated with systemic lupus erythematosus. J Rheumatol. 1991;18(2):280–282
  37. Avina-Zubieta JA, Galindo-Rodriguez G, Robledo I, Vela-Ojeda J, Vadillo-Buenfil M, Rosas-Cabral A, et al. Long term effectiveness of danazol corticosteroids and cytotoxic drugs in the treatment of hematologic manifestations of systemic lupus erythematosus. Lupus. 2003;12:52–57
  38. Chan AY, Li EK, Tam LS, Cheng G, Choi PC. Successful treatment of pure red cell aplasia associated with systemic lupus erythematosus with oral danazol and steroid. Rheumatol Int. 2005;25:388–390
  39. MIMS Online Australia. CMPMedica Australia 2009.
  40. Morley KD, Parke A, Hughes GRV. Systemic lupus erythematosus: two patients treated with danazol. Br Med J. 1982;284:1431–1432
  41. Nettis E, Colanardi C, Loria P, Vacca A. Acquired C1-inhibitor deficiency in a patient with systemic lupus erythematosus: a case report and review of the literature. Eur J Clin Invest. 2005;35:781–784
  42. Ochonisky S, Intrator L, Wechsler J, Bagot M. Acquired inhibitor deficiency revealing systemic lupus erythematosus. Dermatology. 1993;186:261–263
  43. Nagy L, Hannema A, Swaak A. Acquired C1 inhibitor deficiency associated with systemic lupus erythematosus, secondary antiphospholipid syndrome and IgM monoclonal paraproteinaemia. Clin Rheumatol. 1999;18:56–58
  44. Nakamura S, Yoshinari M, Saku Y, Hirakawa K, Miishima C, Murai K, et al. Acquired C1 inhibitor deficiency associated with systemic lupus erythematosus affecting the central nervous system. Ann Rheum Dis. 1991;50:13–16
  45. Cacoub P, Fremeaux-bacchi V, De Lacroix I, Guillien F, Kahn MF, Kazatchkine D, et al. A new type of acquired C1 inhibitor deficiency associated with systemic lupus erythematosus. Arthritis Rheum. 2001;44:1836–1840
  46. Ordi-Ros J, Paredes J, Detarsio G, Vilardell M. Autoantibodies to C1 inhibitor in patients with lupus disease. J Rheumatol. 1997;24:1856–1857
  47. Jazwinska EC, Gatenby PA, Dunckley H, Serjeantaon SW. C1 inhibitor functional deficiency in systemic lupus erythematosus (SLE). Clin Exp Immunol. 1993;92:268–273
  48. Rodriquez M, Ancochea J, De Buen C, Merino JL, Marques G, Vivanco F. Acquired C1-inhibitor deficiency associated with a lupus-like anticoagulant activity. Ann Allergy. 1989;61:348–360
  49. Barilla-Labarca ML, Gioffre D, Zanichelli A, Cicardi M, Atkinson JP. Acquired C1 esterase inhibitor deficiency in two patients presenting with a lupus-like syndrome and anticardiolipin antibodies. Arthritis Rheum. 2002;47:223–226
  50. Donaldson VH, Hess EV, McAdams AJ. Lupus erythematosus like disease in three unrelated women with hereditary angioneurotic edema. Ann Intern Med. 1977;86:312–313
  51. Masse R, Youinou , Dorval JC, Cledes J. Reversal of lupus-erythematosus like disease with danazol. Lancet. 1980;2(8195):651
  52. Donaldson VH, Hess EV. Effect of danzol on lupus-erythematosus like disease in hereditary angioneurotic oedema. Lancet 1145;2(8204):1145.
  53. Nordstrom DM, West SG, Rubin RL. Methydopa induced systemic lupus erythematosus. Arthritis Rheum. 1989;32(2):205–208
  54. David J. Hyperglucagonaemia and treatment with Danazol for systemic lupus erythematosus. Br Med J. 1985;291:1153
  55. Gareth W, Fiona L, Hermann F, Stephen B. Treatment with danazol and plasma glucagons concentration. Br Med J. 1985;291:1155–1156
  56. Weill BJ, Menkes CJ, Cormier C, Louvel A, Dougadoss M, Houssin D. Hepatocellular carcinoma after danazol therapy. J Rheumatol. 1988;15(9):1447–1449
  57. Buamah PK. An apparent danazol induced primary hepatocellular carcinoma: case report. J Surg Oncol. 1985;28:114–116
  58. Osvaldo H. Nodular transformation of the liver in a patient with systemic lupus erythematosus. J Rheumatol. 1989;16(3):410–412
  59. Chevalier X, Awada H, Baetz A, Amor B. Danazol induced pancreatitis and hepatitis. Clin Rheumtol. 1990;9(2):239–241

 The authors have no conflicts of interest to disclose.

PII: S0049-0172(10)00051-X

doi: 10.1016/j.semarthrit.2010.03.005

Seminars in Arthritis and Rheumatism
Volume 40, Issue 4 , Pages 298-306 , February 2011