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Anesi SD, Chang PY, Maleki A, Manhapra A, Look-Why S, Asgari S, Walsh M, Drenen K, Foster CS. Effects of Subcutaneous Repository Corticotropin Gel Injection on Regulatory T Cell Population in Noninfectious Retinal Vasculitis. Ocul Immunol Inflamm 2023; 31:556-565. [PMID: 35258389 DOI: 10.1080/09273948.2022.2042323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/05/2022] [Indexed: 10/18/2022]
Abstract
AIM To evaluate the effect of repository corticotropin injection (RCI) on regulatory T cell population in patients with noninfectious retinal vasculitis. PATIENTS AND METHODS Patients with active noninfectious retinal vasculitis were included in a prospective nonrandomized open-label study. RESULTS Eighteen patients (33 eyes) were included in the study. Eleven (61.1%) patients [20 (60.6%) eyes] and 7 (38.9%) patients [13 (33.3%) eyes] were in the responsive and non-responsive groups, respectively. We did not find any statistically significant difference within the PPP-R group, within the PPP-NR group, or between these two groups in regard to regulatory T cell population. No significant systemic or ocular complications were found. CONCLUSION RCI may be a complementary treatment in patients with non-infectious retinal vasculitis with or without uveitis. This study did not demonstrate an increase in regulatory T cell population in patients with noninfectious retinal vasculitis.
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Affiliation(s)
- Stephen D Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Peter Y Chang
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Ambika Manhapra
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Sydney Look-Why
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Soheila Asgari
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Marisa Walsh
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Kayla Drenen
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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Anesi SD, Chang PY, Maleki A, Stephenson A, Montieth A, Filipowicz A, Syeda S, Asgari S, Walsh M, Metzinger JL, Foster CS. Treatment of Noninfectious Retinal Vasculitis Using Subcutaneous Repository Corticotropin Injection. J Ophthalmic Vis Res 2021; 16:219-233. [PMID: 34055260 PMCID: PMC8126741 DOI: 10.18502/jovr.v16i2.9086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 02/01/2021] [Indexed: 11/24/2022] Open
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-wide-field 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.
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Affiliation(s)
- Stephen D Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Peter Y Chang
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Andrew Stephenson
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Alyssa Montieth
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Artur Filipowicz
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Sarah Syeda
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Marisa Walsh
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - Jamie Lynne Metzinger
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.,The Ocular Immunology and Uveitis Foundation, Waltham, MA, United States.,Harvard Medical School, Department of Ophthalmology, Boston, MA, United States
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Saygin D, Oddis CV, Marder G, Moghadam-Kia S, Nandkumar P, Neiman N, Dzanko S, Koontz D, Aggarwal R. Follow-up results of myositis patients treated with H. P. Acthar gel. Rheumatology (Oxford) 2020; 59:2976-2981. [PMID: 32160301 DOI: 10.1093/rheumatology/keaa076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/20/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Idiopathic inflammatory myopathies (IIM) are a group of autoimmune diseases characterized by proximal muscle weakness. H. P. Acthar gel [repository corticotropin injection (RCI)] is a formulation of adrenocorticotropic hormone and has been approved by Food and Drug Administration for use in IIM; however, literature is limited. In this study, we report longitudinal follow-up of myositis patients treated with RCI. METHODS Patients with refractory IIM who were enrolled in the prospective, open-label RCI trial were included in this study. The post-trial follow-up period was 6 months with assessments every 2 months, which included myositis core set measures including extra-muscular global, muscle and patient global disease activities, HAQ, and manual muscle testing. RESULTS Two patients were lost to follow-up after finalization of the trial, and the remaining eight patients were enrolled in the follow-up study. One patient remained on RCI after the trial. In the follow-up period, four of eight patients had flare at on average 4.1 months after the RCI trial. Among the patients who flared, three required an increase in prednisone. One patient was restarted on RCI at 5.5 months, but had minimal improvement after 3 months. Four patients who remained stable continued to satisfy criteria for the definition of improvement through the 6-month follow-up. However, none showed any further improvement in the primary or secondary efficacy outcomes after the initial RCI trial. CONCLUSION To our knowledge, this is the first study reporting the follow-up results of patients treated with standard dose and duration of Acthar. We believe that our study will provide the basis for the development of future randomized RCI trials in IIM.
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Affiliation(s)
- Didem Saygin
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Galina Marder
- Division of Rheumatology, Northwell Health, Formerly North Shore-Long Island Jewish Medical Center, Queens, NY, USA
| | - Siamak Moghadam-Kia
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Preeya Nandkumar
- Division of Rheumatology, Northwell Health, Formerly North Shore-Long Island Jewish Medical Center, Queens, NY, USA
| | | | - Sedin Dzanko
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Diane Koontz
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
The ability of the adrenocorticotropic hormone (ACTH) to induce steroidogenesis and upregulate anti-inflammatory processes has long been known. More recently, however, extrasteroidal mechanisms, through which ACTH exerts anti-inflammatory processes, have been described. This has renewed hope that ACTH can combat inflammatory conditions even when resistant to steroids. This review article summarizes the literature on the use of ACTH in ocular disease. Unfortunately, much of the data regarding the clinical utility of ACTH are outdated, with many studies published in the 1950s and 1960s. Many of these older studies are inconsistent or incomplete with their reporting, making it difficult to ascertain the meaning of the outcomes. Despite the limitations, 2 important trends are evident. First, when used to treat an inflammatory disease, ACTH can be effective at decreasing or eliminating ocular inflammation, even in a refractory disease resistant to multiple treatment modalities. Second, adverse effects of ACTH are rare and are most likely to be reported with relatively high doses of ACTH therapy. Taken as a whole, these studies offer initial promising data that ACTH may be a safe and effective alternative in refractory ocular inflammatory disease. However, they highlight an important lack of prospective data to more rigorously understand the true safety and efficacy of this therapy.
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Affiliation(s)
- Alexander B Crane
- Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, Newark, New Jersey, USA
| | - Yael Sharon
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
| | - David S Chu
- Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, Newark, New Jersey, USA.,Metropolitan Eye Research and Surgery Institute, Palisades Park, New Jersey, USA
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Hartung DM, Johnston K, Deodhar A, Bourdette DN, Cohen DM. Repository Corticotropin Versus Glucocorticoid for Nephrotic Syndrome: When Will We See the Evidence? Am J Kidney Dis 2019; 74:256-262. [PMID: 30765104 DOI: 10.1053/j.ajkd.2018.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/04/2018] [Indexed: 01/13/2023]
Abstract
Despite little evidence supporting its superiority to glucocorticoid therapy, use and expenditures for repository corticotropin (rACTH) injection (H.P. Acthar Gel; Mallinckrodt) have increased dramatically in the last 5 years, particularly among a small number of nephrologists, rheumatologists, and neurologists. Recently, the manufacturer justified the extremely high and rapidly increasing cost of rACTH by citing the ongoing need to generate clinical data to support its use. We test this assertion by investigating the quality and provenance of the evidence likely to emerge in the foreseeable future. We identified all completed, in-progress, and proposed studies of rACTH registered at ClinicalTrials.gov. 75 studies representing 2,953 participants met inclusion criteria. Studies addressed primarily nephrologic (n = 23), rheumatologic (n = 28), and neurologic (n =22) indications. Of the 23 studies proposed for renal indications (enrollment, 33 ± 49 [mean ± SD]), 11 were not randomized, 8 compared only different rACTH treatment regimens, and 4 compared rACTH to placebo. No studies of rACTH proposed for renal indications included an rACTH-free arm receiving active treatment (ie, another form of immunosuppression). We conclude that evidence emerging in the foreseeable future is unlikely to broadly support rACTH use over lower-cost glucocorticoid-based alternatives for renal indications.
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Affiliation(s)
- Daniel M Hartung
- College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland, OR
| | - Kirbee Johnston
- College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland, OR
| | - Atul Deodhar
- Division of Rheumatology, Department of Medicine, Oregon Health & Science University, Portland, OR
| | - Dennis N Bourdette
- Department of Neurology, Oregon Health & Science University, Portland, OR; VA Portland Health Care System, Research Service, Portland, OR; MS Center of Excellence-West, VA Portland Health Care System, Portland, OR
| | - David M Cohen
- VA Portland Health Care System, Research Service, Portland, OR; Division of Nephrology and Hypertension, Department of Medicine, Oregon Health & Science University, Portland, OR.
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Groves AP, Reich P, Sigdel B, Davis TK. Pneumococcal hemolytic uremic syndrome and steroid resistant nephrotic syndrome. Clin Kidney J 2016; 9:572-5. [PMID: 27478599 PMCID: PMC4957713 DOI: 10.1093/ckj/sfw025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/14/2016] [Indexed: 12/31/2022] Open
Abstract
Pneumococcal-associated hemolytic uremic syndrome (pHUS) is a rare but severe complication of invasive Streptococcus pneumoniae infection. We report the case of a 12-year-old female with steroid-resistant nephrotic syndrome treated with adrenocorticotrophic hormone (H.P. Acthar(®) Gel), who developed pneumococcal pneumonia and subsequent pHUS. While nephrotic syndrome is a well-known risk factor for invasive pneumococcal disease, this is the first reported case of pHUS in an adolescent patient with nephrotic syndrome, and reveals novel challenges in the diagnosis, treatment and potential prevention of this complication.
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Affiliation(s)
- Andrew P Groves
- Washington University School of Medicine , St Louis, MO , USA
| | - Patrick Reich
- Division of Infectious Disease, Department of Pediatrics , Washington University School of Medicine , St Louis, MO , USA
| | - Binayak Sigdel
- Division of Critical Care Medicine, Department of Pediatrics , Washington University School of Medicine , St Louis, MO , USA
| | - T Keefe Davis
- Division of Nephrology, Department of Pediatrics , Washington University School of Medicine , St Louis, MO , USA
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Baughman RP, Barney JB, O'Hare L, Lower EE. A retrospective pilot study examining the use of Acthar gel in sarcoidosis patients. Respir Med 2015; 110:66-72. [PMID: 26626451 DOI: 10.1016/j.rmed.2015.11.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 11/09/2015] [Accepted: 11/12/2015] [Indexed: 01/11/2023]
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.
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Affiliation(s)
| | | | - Lanier O'Hare
- University of Alabama Birmingham, Birmingham, AL, USA
| | - Elyse E Lower
- University of Cincinnati Medical Center, Cincinnati, OH, USA
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Zhou Y, Lower EE, Li H, Baughman RP. Sarcoidosis patient with lupus pernio and infliximab-induced myositis: Response to Acthar gel. Respir Med Case Rep 2015; 17:5-7. [PMID: 27222775 PMCID: PMC4821248 DOI: 10.1016/j.rmcr.2015.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/05/2015] [Accepted: 11/08/2015] [Indexed: 11/09/2022] Open
Abstract
Infliximab is an effective treatment for sarcoidosis patients with persistent disease despite glucocorticoids and immunosuppressive therapy. Patients receiving infliximab can experience side effects, inducing an autoimmune reaction. Treatment is unclear for sarcoidosis patients who develop autoimmune reactions to infliximab. We report a case of a patient with advanced sarcoidosis who developed a myositis type reaction to infliximab characterized by diffuse muscle achiness and weakness and marked elevations in serum creatinine phosphokinase (CPK) and aldolase. Manifestations of sarcoidosis and myositis improved after Acthar treatment. This is the first report of successful treatment with Acthar in a patient with advanced sarcoidosis with an autoimmune reaction to infliximab.
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Affiliation(s)
- Ying Zhou
- Department of Internal Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH, 45267, USA; Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Elyse E Lower
- Department of Internal Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH, 45267, USA
| | - Huiping Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Robert P Baughman
- Department of Internal Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH, 45267, USA
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