July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
An old therapy to treat a current problem: use of adrenocorticotrophic hormone in non-infectious panuveitis
Author Affiliations & Notes
  • Yasmin Islam
    Ophthalmology, University of Florida, Gainesville, Florida, United States
  • Gibran Khurshid
    Ophthalmology, University of Florida, Gainesville, Florida, United States
  • Footnotes
    Commercial Relationships   Yasmin Islam, None; Gibran Khurshid, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3509. doi:
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      Yasmin Islam, Gibran Khurshid; An old therapy to treat a current problem: use of adrenocorticotrophic hormone in non-infectious panuveitis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3509.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Non-infectious panuveitis (NIP) can be challenging to treat, and patients with recalcitrant NIP can become reliant upon oral corticosteroids or immunosuppression to keep their disease at bay; however, these bring a multitude of side effects, have daily dosing, and require close follow-up. There is growing interest in using alternative options to treat NIP. In this case series, we describe the use of subcutaneous adrenocorticotrophic hormone (ACTH) gel (Acthar®, Mallinckrodt pharmaceuticals) to successfully treat five patients with recurrent NIP who were otherwise reliant on systemic corticosteroids to control their inflammation and maintain useful vision.

Methods : This is a retrospective case series of five patients (ten eyes) with bilateral NIP who were treated at an academic medical center with ACTH. Three had idiopathic NIP, one had sarcoidosis, and one had ankylosing spondylitis. Ages ranged from twenty-four to forty-eight; four patients were male. Four patients had recurrences of uveitis after stopping oral corticosteroids; the fifth patient refused oral corticosteroids. All five were treated with eighty units of subcutaneous ACTH gel twice weekly until remission was achieved. They then transitioned to forty units of ACTH twice weekly for maintenance.

Results : All five patients have had sustained remission of their NIP for over one year with ACTH gel. Post-ACTH administration, there was significant improvement in vision and control of NIP. In all ten eyes, visual acuity improved with ACTH gel administration, with eight of ten eyes achieving 20/20 to 20/40 VA from pre-treatment ranges of 20/100 to 20/400. All five patients achieved remission in three to five weeks after starting ACTH. No systemic side effects were observed.

Conclusions : Subcutaneously-administered ACTH gel is a promising alternative to long-term oral corticosteroids to treat patients with recurrent NIP and results in marked improvement in visual acuity. Further research is needed to determine the sustainability of remission over years, as well as to compare ACTH gel to other corticosteroid-sparing treatments in terms of efficacy and tolerability.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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