PURPOSE: Acthar gel is a purified repository gel preparation of adrenocorticotropic hormone (ACTH1-39), a melanocortin peptide that can bind and activate specific melanocortin receptors (MCRs) leading to immunosuppression. A recent report indicated that Acthar gel was effective in treating some advanced sarcoidosis patients (Baughman et al. Respir Med 2016; 110: 66-72). To better understand the immunosuppressive activity of Acthar gel in sarcoidosis patients, we performed serial blood sampling for cytokine analysis of sarcoidosis patients before and after 3-6 months of therapy. METHODS: Patients with advanced sarcoidosis who remained symptomatic despite systemic treatment of their disease were begun on 40-80 units of Acthar gel twice a week. Serum samples were obtained initially, after 2-5 months, and after 6 months of therapy. All other treatments for sarcoidosis were continued at the start of initiating Acthar gel. Treatment at time of starting therapy and initial dose of prednisone was noted. During the six months of study, some patients had their dose of prednisone reduced base on clinical response to Acthar gel. Serum was stored at-70 C and later analyzed using a luminex plate technique. A panel of inflammatory cytokines was study and results are reported as picograms/ml. RESULTS: A total of 24 patients had at least one paired sample analyzed, with 10 patients having sample measured after 5 or more months of Acthar gel. All patients were receiving one or more systemic treatment for their sarcoidosis at time of starting Acthar gel, including 19 patients on prednisone (median 10 mg, range 5 to 40 mg). Not all patients had detectable cytokines at all time points. After 2-5 months of Acthar gel therapy, many of the cytokines had no significant change in serum levels. However, several patients had some specific cytokines demonstrating a >10% drop. These include: SCD40L: 11/24 (number >10% fall/ numbr tested);

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