Abstract
Purpose :
Sarcoidosis is a multisystem inflammatory disease with protean manifestations. 30%-60% of patients with sarcoidosis develop ocular disease. Corticosteroids remain the mainstay of treatment. In patients with steroid-dependent disease, steroid-sparing therapies have been tried with variable success. More recently, a corticotropin gel given as a subcutaneous repository injection (H.P. Acthar Gel ® Mallinckrodt Pharmaceuticals, St. Louis, MO) has been proposed as treatment. It acts as adrenocorticotropic hormone affecting the adrenal gland cortex globally, causing the release of glucocorticoids responsible for control of inflammation. Here, we sought to investigate the efficacy and side effects of Acthar for ocular sarcoidosis.
Methods :
Retrospective, observational case series of five patients with ocular sarcoidosis treated with Acthar identified from 01/2015 to 11/2018 at the University of Illinois at Chicago. Patient demographics, medical history, and date of initiation, dose, cessation, reason for cessation, and side effects of Acthar were collected. Approval of the study was obtained from the Institutional Review Board.
Results :
Three patients had uveitis, one had optic neuritis and one had both uveitis and optic neuritis. Four patients were female, one was male. All patients were African-American and were treated with oral prednisone prior to initiation of Acthar. Three patients had received systemic immunomodulatory therapy prior to Acthar therapy. Acthar was commenced for steroid-dependent disease and/or failure of systemic immunomodulatory therapy. The range of active Acthar treatment time was 4-16 months (average 8.9 months) although this included discontinuous use given insurance approval and denial for two patients. Four patients had side-effects - three had skin hyperpigmentation, one had increased IOP, one had alopecia, and two had hypertension.
Conclusions :
In our case series, Acthar did not have significant benefit for the five patients who presented with various ocular manifestations of sarcoidosis. Given the adverse effects and difficulty with insurance approval due to medication cost, existing modalities of immunosuppression including oral prednisone and immunomodulatory treatment for ocular sarcoidosis may be considered.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.