A retrospective pilot study examining the use of Acthar gel in sarcoidosis patients. (January 2016)

• Record Type: Journal Article
• Authors: Baughman, Robert P.; Barney, Joseph B.; O'Hare, Lanier; Lower, Elyse E.
• Is Part Of: Respiratory medicine. Volume 110(2016)
• Page Start: 66
• Page End: 72
• Publication Date: 2016-01
• Subjects: Pulmonary sarcoidosis -- Acthar -- Corticotrophin -- Infliximab; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2015.11.007
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Introduction: Acthar was reported as effective for the treatment of pulmonary sarcoidosis in the 1950s. Use of drug waned due to cost and toxicity compared to prednisone. Recent interest has reemerged as an alternative to high dose oral glucocorticoids. Methods: Chart review was performed on all advanced sarcoidosis patients seen at two centers who received at least one dose of Acthar gel therapy with at least six months of posttreatment follow up. In all cases prior sarcoidosis therapy and indications for use along with clinical outcome were noted. All patients initially received 80 IU intramuscular or subcutaneous administration twice a week. Results: A total of 47 patients were treated with Acthar gel therapy during the study period, and 18 (37%) discontinued drug within six months due to cost (four patients), death (two patients), or drug toxicity (eleven patients), or noncompliance (1 patient). Of the remaining 29 patients, eleven experienced objective improvement in one or more affected organs. All but two patients noted disease improvement or oral glucocorticoid reduction. Twenty-one patients were treated for more than six months (Median 274 days). Nineteen patients were on prednisone at time of starting Acthar gel: seventeen had their prednisone dosage reduced by more than fifty percent and one patient discontinued cyclophosphamide therapy. Conclusion: In this group of advanced sarcoidosis patients, Acthar gel treatment for at least three months was associated with objective improvement in a third of patients. A third of patients were unable to take at least a three months of treatment. Highlights: Acthar gel was tolerated in majority of treated patients. In those patients who received more than 3 months of treatment, half had improvement in their disease. In those patients who received more than 3 months of treatment, almost all had prednisone dose reduced.