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Alexander B Crane, Yael Sharon, David S. Chu; Repository Corticotropin Injection (RCI) in Ocular Inflammation: A Case Series and Literature Review. Invest. Ophthalmol. Vis. Sci. 2018;59(9):427.
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This is a retrospective study of 7 patients with refractory inflammatory ocular conditions treated with RCI—an adrenocorticotropic hormone (ACTH) analogue—to examine its role in treating ocular inflammation. Additionally, a literature review of treatment with RCI for ocular diseases was performed.
Patient- and disease-related data were reviewed retrospectively from medical records. The cohort included 5 patients with panuveitis (ages 36-69) and 2 patients with ocular cicatricial pemphigoid (ages 75-80) treated with RCI. Additionally, a literature review of PubMed was performed with the search terms ((“repository corticotropin injection” OR “corticotropin” OR “corticotrophin” OR “acthar gel” OR “ACTH”) AND (“ocular inflammation” OR “uveitis” OR “optic” OR “eye”)). Articles were included that described patients 1) with an ocular condition, 2) treated with RCI, and 3) with follow-up.
RCI treatment was given to 7 patients with chronic, bilateral, inflammatory ocular disease. Patients had previously been treated with topical/systemic steroids and immunomodulatory therapy, however symptoms persisted and/or side effects developed. RCI therapy was associated with decreased inflammation in 6 of 7 patients (86%), no change in inflammation in 1 of 7 patients (14%), and no significant adverse events in 7 of 7 patients (100%). Mean follow-up was 10 months (range 5 weeks to 15 months), and mean dose of Prednisone was tapered from 14 mg/day to 7 mg/day.The literature review revealed 20 articles, including 3 recent articles (2015-present, 5 patients) and 17 older articles (1950-1974, 335 patients). Recent reports described 1 patient with uveitis, 1 with optic neuritis (ON) along with systemic autoimmune diseases, and 3 with sarcoidosis with ocular involvement. Inflammation decreased in 4 (80%) patients, and did not change in 1 (20%) patient. The older articles reported mixed success in using RCI to treat ON, keratoconjunctivitis sicca, syphilitic interstitial keratitis, herpes zoster ophthalmicus, ocular myasthenia gravis, glaucoma, and uveitis, among others.
RCI has the potential to be a safe and effective alternative treatment for ocular inflammation. However, most available clinical data are from over 4 decades ago, often with inconsistent outcome measures and treatment plans. Further clinical studies are needed to evaluate RCI’s role in treating ocular inflammation.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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