Adrenocorticotropic hormone gel for patients with non-infectious uveitis

Abstract

Purpose To describe the potential role of adrenocorticotropic hormone (ACTH) gel treatment in patients with chronic non-infectious uveitis. Observations We report the clinical course of three patients with bilateral, non-infectious anterior and intermediate uveitis, treated with ACTH gel for ≥12 months. All three patients had chronic and steroid-dependent ocular inflammation with subsequent development of ocular complications. Twice-weekly treatment with subcutaneous 80 unit/day ACTH gel was administered, and clinical outcome measures were observed. After a mean period of 14 months, all patients demonstrated significant improvement in disease activity, stable visual acuity, and an absence of side effects. Systemic steroids dosage was successfully reduced from a mean dose of 16 mg/day upon the initiation of ACTH gel treatment to 2 mg/day at last follow up. Conclusions and Importance Subcutaneous ACTH gel has shown to be a safe and effective therapy in the management of non-infectious uveitis. Specifically, ACTH gel plays a role in refractory and steroid-dependent cases and in those who do not respond to or are unable to tolerate other immunomodulatory therapies.

Treatment of Noninfectious Retinal Vasculitis Using Subcutaneous Repository Corticotropin Injection

“…[21] There are only two previously published case reports of use of RCI in a patient with intraocular inflammation -a patient with panuveitis and diffuse RV, who had previously failed systemic corticosteroid therapy and intravenous tocilizumab, showing sustained improvement in disease activity in this patient at the same dose used in this study, [22] as well as a series of three patients with bilateral, noninfectious anterior and intermediate uveitis who showed improvement in inflammation, stable vision, and ability to reduce mean systemic steroid without any reportable side effects over 14 months of therapy. [23] These examples highlight the importance of further investigation into newer and possibly more effective means of treating RV, such as RCI, especially considering some patients may fail or have a contraindication or adverse reaction to other known typically effective medications.…”

Fda-Approved Indications of Adrenocorticotropic Hormone (Acth) as a Drug: Does It Have a Place in Disease Management Today?

“…Nguyen et al [16], Sharon et al [17] and Nelson et al [18] eye uveitis Bryan et al [20] eye optic neuritis Wirta et al [21] eye keratitis Anesi et al [22] eye retinal vasculitis Cusick et al [38], Kaplan et al [39], [40], Hunter et al [41] nervous system multiple sclerosis Chugani et al [44], Knupp et al [45], O'Callaghan et al [47], Yin et al [50] pediatrics infantile spasms Gills et al [55], Fleischmann et al [57] musculoskeletal rheumatoid arthritis Furie et al [66,67], Askanase et al [68,69] musculoskeletal sle Aggarwal et al [74] musculoskeletal inflammatory myopathy Baughman et al [75], Chopra et al [76], Rahaghi et al [77] musculoskeletal sarcoidosis Daoussis et al [85], [86], Xu et al [91] musculoskeletal gout…”

“…Since the 1950s Woods et al [14] and Gordon et al [15] discussed the basic uses and limitations of ACTH and corticosteroids in ocular disease. Three more recent studies by Nguyen et al [16], Sharon et al and [17] Nelson et al [18] agreed that corticotropin injections (CIs) have a place especially in refractory to corticosteroids uveitis of noninfectious cause. The safety profile was favorable too.…”

Publication bias, Open-Labeled Trials and Sky Rocketing Costs- Past, Present and Future of Repository Corticotropin Injection?

“…The authors of one series of uveitis patients treated with RCI raised the question regarding the use of RCI as a maintenance therapy in chronic NIU given its high cost. 3 The cost of RCI has soared in the past 20 years through various pharmaceutical company acquisitions, going from 40 USD per vial to 1650 USD per vial in 2001 after Questcor acquired the drug and then overnight to 23,000 USD per vial in 2007. 17 The company justified the cost increase due to infrequent use of the drug for infantile spasms.…”