Repository corticotropin injection in patients with advanced symptomatic sarcoidosis: retrospective analysis of medical records

Abstract

Background:Repository corticotropin injection (RCI) has regulatory approval for many indications, including symptomatic sarcoidosis. This large case series of patients with advanced symptomatic sarcoidosis treated with RCI describes patient characteristics, RCI utilization patterns, concomitant therapies, and physicians’ assessments of treatment response.Methods:Patients ⩾18 years with symptomatic sarcoidosis, treated with RCI in the previous 36 months, who had completed a course of RCI or received RCI for ⩾6 months at the time of data collection were included.Results:The study included 302 patients (mean age, 51 years; 52%, women) with a mean 4.8 years since initial diagnosis of sarcoidosis. Most patients (76%) had extrapulmonary involvement, primarily in the skin (28%), joints (25%), heart (22%), and eyes (22%); 34% had multiple (⩾2) organ involvement. The mean duration of RCI treatment was 32.5 weeks, with 61.6% of patients continuing RCI therapy for ⩾6 months. The RCI utilization pattern indicated an individualized approach to therapy, with a higher starting dose associated with a shorter duration of therapy compared with a lower starting dose. The percentage of patients who used corticosteroids decreased from 61.3% during the 3 months before initiation of RCI to 12.9% 3 months after RCI therapy; the mean daily dose of corticosteroid decreased from 18.2 mg to 9.9 mg. The proportion of patients given <10 mg/day of prednisone increased from 21% before RCI use to 47% 3 months after RCI use. According to physicians’ assessments of change in patients’ health status after RCI therapy, overall status improved in 95% of patients, overall symptoms in 73%, lung function in 38%, and inflammation in 33%.Conclusions:The findings suggest that RCI is a viable treatment option for patients with advanced symptomatic sarcoidosis and provide insights on patient characteristics and practice patterns to help clinicians determine appropriate use. The reviews of this paper are available via the supplemental material section.

Real-World Treatment Patterns and Outcomes from an Electronic Medical Records Database for Patients with Rheumatoid Arthritis Treated with Repository Corticotropin Injection

“…This study did not analyze daily dose changes of glucocorticoids that could have been impacted by RCI treatment as assessed in previous studies. 30 , 32 Taken together, we observed changes in standard RA treatments that were sustained for up to 1 year after RCI initiation that are consistent with the improvements in clinical measures of disease severity and PROs.…”

<p>Treatment with Repository Corticotropin Injection in Patients with Rheumatoid Arthritis, Systemic Lupus Erythematosus, and Dermatomyositis/Polymyositis</p>

“…In clinical settings, it is often used after other therapies have failed. 22,23 Due to this unique place in therapy, the literature contains very little information about the profile of patients who would benefit most from RCI therapy or how the therapies are used. Therefore, it is imperative to describe these aspects of real-world data to help ensure appropriate use.…”

Management of repository corticotrophin injection therapy for pulmonary sarcoidosis: a Delphi study

“…The study also found that an RCI dosage of 40 units twice a week was as effective as 80 units and appeared to be better tolerated [17]. In another retrospective study, CHOPRA et al [24] reviewed 302 sarcoidosis patients and reported that >90% had improvement of their symptoms. Note that this study had not yet been published when the Delphi panels were conducted.…”