Repository corticotropin injection in patients with refractory psoriatic arthritis: a case series

Abstract

PurposeAlthough numerous treatment options are available for patients with psoriatic arthritis (PsA), a need for effective and tolerable treatments remains for patients with refractory disease who have failed previous therapies and continue to experience tender and/or swollen joints, pain, and disease activity. Repository corticotropin injection (RCI) is believed to produce steroidogenic, steroid-independent, anti-inflammatory, and immunomodulatory effects in patients with rheumatic disorders, such as PsA. Limited literature exists on the use of RCI in patients with refractory PsA. The objective of this case series is to provide information on the clinical features of patients with refractory PsA and their response to RCI.PatientsNine patients treated with RCI for refractory PsA were retrospectively identified and included in the case series.ResultsAll the nine patients experienced at least transient improvements in their active skin and joint disease. In some patients, it was necessary to titrate the RCI to an appropriate dose. RCI was used in some patients to bridge with another PsA therapy, such as apremilast or certolizumab. RCI was well tolerated, but discontinued in three patients due to preexisting conditions (hypertension and hyperglycemia).ConclusionRCI may be a safe and effective option for patients with refractory PsA who failed therapy with multiple previous treatments.

Fda-Approved Indications of Adrenocorticotropic Hormone (Acth) as a Drug: Does It Have a Place in Disease Management Today?

“…Unfortunately, ACTH lacks modern data and new randomized controlled trials (RCTs) supporting its clinical significance in axial spondylarthritis. An exception would be a case series by Brown et al [64], where they treated 9 difficult-to-treat psA patients with CI and noticed some improvement in skin and joint disease.…”

Pain and Fatigue Improvements in Patients Treated with Repository Corticotropin Injection Across Five Indications: A Narrative Review

“…Real-world experience with RCI has been reported in case series in patients with psoriatic arthritis and SLE [ 17 , 18 ]; in retrospective chart reviews in patients with sarcoidosis, RA, various rheumatologic diseases, uveitis, SLE, and dermatomyositis/polymyositis (DM/PM) [ 7 , 19 – 22 ]; and in claims database analyses in patients with RA, other rheumatologic conditions, and SLE [ 23 , 24 ]. These types of studies show that in routine clinical practice, patients who receive RCI tend to have difficult-to-treat disease and have tried multiple available alternative treatments without successful resolution of symptoms.…”

A Retrospective Medical Record Review of Utilization Patterns and Medical Resource Use Associated with Repository Corticotropin Injection among Patients with Rheumatologic Diseases in the United States

“…Recent progress in understanding the effects of RCI in modulating immune responses has led to increased interest in RCI as a therapeutic choice [2]. Clinical trials and retrospective case series have found RCI to be effective for reducing disease activity and signs/symptoms as well as improving functional status in patients with RA, PsA, DM/PM, and SLE [3][4][5][6][7][8][9][10][11][12]. Claims data studies that examined medical resource use (MRU) relating to rheumatologic disorders reported that RCI treatment was associated with reduced health care utilization [13,14].…”