Treatment of Noninfectious Retinal Vasculitis Using Subcutaneous Repository Corticotropin Injection

Abstract

Purpose: To show whether subcutaneous repository corticotropin injection (RCI, Acthar® Gel, a repository corticotropin injection, can be an effective potential therapeutic agent for noninfectious retinal vasculitis.
 Methods: Patients with active retinal vasculitis were followed with serial ultra-widefield fluorescein angiograms and treated with 80 units of subcutaneous repository corticotropin injection twice weekly.
 Results: Primary outcome of ≥50% improvement in response level (RL) for retinal vasculitis and percent improvement in retinal vasculitis severity scoring (RVSS) by more than one quartile (≥25%) at week 12 was met in 15 and 16 of the 30 total eyes, respectively, including 1 eye with severe retinal vasculitis in each group. Complete resolution of retinal vasculitis was seen in seven eyes with a mean time of 17.1 weeks. Intraocular pressure elevation requiring therapy and cataract progression were noted in two and three eyes, respectively. One patient stopped medication due to side effects (injection site reaction).
 Conclusion: Repository corticotropin injection was well-tolerated overall. Repository corticotropin injection may be an effective therapeutic agent in the treatment of noninfectious retinal vasculitis.

Treatment of non-infectious retinal vasculitis

“…In 2021, the first prospective study of patients with RV treated with repository corticotropin injection (RCI) showed that it was effective and well tolerated by patients. 21 The results reported more than 50% improvement in RV disease activity by week 12 in half of the eyes and complete resolution of RV in seven eyes in a mean time of 17.1 weeks. In this study, two eyes experienced elevations in intraocular pressure, and three eyes were noted to have formation of cataracts; one patient had to stop the medication due to an injection site reaction.…”

“…Recommended therapeutic options include anti-inflammatory regimens involving systemic corticosteroids in the short term and local steroids, if necessary, followed by steroid-sparing therapy using immunosuppressive medications, including chemotherapeutic (disease-modifying antirheumatic drugs or DMARDs) or biologic agents for the long term. 21 …”

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

“…In a recent prospective open-label study performed in a tertiary care uveitis center Anesi et al [22] treated 19 retinal vasculitis (RV) patients (for 30 total insulted eyes) with subcutaneous (SC) 80-unit corticotropin injections twice weekly for 24 weeks. The RV was noninfectious but of various etiology.…”

“…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…”

Acthar® Gel Treatment for Patients with Autoimmune and Inflammatory Diseases: An Historical Perspective and Characterization of Clinical Evidence

“…In a prospective, open-label, single-arm study, patients with noninfectious vasculitis showed improvement in retinal vasculitis severity scoring in 16 of 30 eyes following 12 weeks of Acthar therapy. One patient discontinued treatment due to an injection site reaction, but Acthar was well tolerated overall and considered a potentially effective therapy (Table 5 ) [ 56 ].…”