From the Guidelines
ACTHAR gel is primarily used to treat various inflammatory and autoimmune conditions, including multiple sclerosis exacerbations, infantile spasms, rheumatoid arthritis, lupus, and certain nephrotic syndromes, by stimulating the adrenal glands to produce cortisol and other steroid hormones that reduce inflammation. The medication contains adrenocorticotropic hormone (ACTH) and is typically reserved for patients who haven't responded adequately to first-line treatments 1.
Key Uses and Dosage
- Multiple sclerosis exacerbations: 80-120 units daily for 2-3 weeks
- Infantile spasms: 75 units/m² twice daily
- Rheumatoid arthritis, lupus, and certain nephrotic syndromes: dosage varies by condition and patient response
Administration and Side Effects
- Administered as a subcutaneous or intramuscular injection
- Side effects may include increased susceptibility to infections, elevated blood pressure, fluid retention, mood changes, and increased blood sugar
Mechanism of Action
- Works by mimicking the body's natural stress response, triggering anti-inflammatory effects through multiple pathways
It's essential to note that ACTHAR gel is a high-cost medication with potential side effects, and its use is generally recommended when other treatments have failed or aren't tolerated, as stated in the example answer. However, the provided evidence 1 focuses on primary adrenal insufficiency diagnosis, treatment, and follow-up, without directly addressing the use of ACTHAR gel. Therefore, the recommendation is based on the general knowledge of ACTHAR gel's use in clinical practice.
From the Research
Use of Acthar Gel
The use of Acthar Gel, a repository corticotropin injection, is indicated for the treatment of various inflammatory disorders, including:
- Autoimmune and inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis and polymyositis, multiple sclerosis relapse, ophthalmic disorders, sarcoidosis, and nephrotic syndrome 2
- Infantile spasms, with studies showing that Acthar Gel can eliminate spasms in 66% of animals treated with 24 or 32 IU/kg/day 3
- Idiopathic nephrotic syndrome (INS) secondary to minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS), with some patients showing complete or partial response to treatment with Acthar Gel 4
Administration of Acthar Gel
Acthar Gel can be administered via a single-dose prefilled injection device, such as SelfJect, which is intended to simplify its subcutaneous delivery 5. The administration of Acthar Gel via SelfJect is suitable for use in pediatric patients, although an adult should administer the device to pediatric patients 5. The bio-equivalence of intramuscular (IM) and subcutaneous (SQ) administration of Acthar Gel has also been demonstrated, allowing for the use of SQ Acthar Gel as an alternative to IM administration 6.
Key Points
- Acthar Gel is a naturally sourced complex mixture of adrenocorticotropic hormone analogs and other pituitary peptides with both steroidogenic and nonsteroidogenic immunomodulatory effects 2
- The use of Acthar Gel has been studied in various inflammatory diseases, with many publications demonstrating its safety and efficacy in patients for whom standard treatments were ineffective or intolerable 2
- Acthar Gel can be used as a first-line or subsequent therapy in patients with idiopathic nephrotic syndrome (INS) secondary to minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS) 4