Retrospective Medical Record Review to Describe Use of Repository Corticotropin Injection Among Patients with Uveitis in the United States

Abstract

Introduction: Repository corticotropin injection (RCI) has immune-modulatory and anti-inflammatory effects and is approved for multiple indications, including severe and acute chronic allergic and inflammatory processes involving the eye and adnexa. This study describes patient characteristics, treatment patterns, and physicians' assessments of patients with uveitis treated with RCI. Methods: This was a retrospective medical record review of US patients. Eligible patients had a diagnosis of uveitis, received RCI in the past 12 months, and had completed or were receiving RCI treatment at the time of data collection. Baseline characteristics and after-treatment clinical data are descriptively reported. Results: The study included 91 patients (mean age 41 years, 62% female, and mean time since diagnosis 3.98 years). Most patients had moderate ( n = 48, 53%) to severe ( n = 21, 23%) visual impairment, and none was blind before RCI therapy. Patients used an average of 2.5 medications before RCI. Initial RCI dosing regimens, dose adjustments, and treatment durations were different for each patient. Concomitant medication use and dosages were reduced during RCI; 76 patients (84%) improved, 15 patients (16%) stayed the same, and none worsened; 86% of patients had improvements in vision. Conclusions: Physicians individualized RCI therapy among patients who suffered uveitis for several years and when previous therapies were inadequate. Most patients improved after initiating RCI, most commonly in vision. The findings support use of RCI for uveitis and provide a better understanding of patient characteristics and practice patterns to guide appropriate use.

Analysis of the clinical diagnosis and treatment of uveitis

“…Sharma et al (17) found that uveitis is associated with systemic diseases. Nelson et al (18) reported that a specific etiological diagnosis was made in around 61% of patients, and in this study, the etiology was identified or combined with systemic diseases in 60.1% of the patients. It has been reported in the literature that rheumatic diseases predispose patients to the development of uveitis and damage to ocular tissues, and other diseases, such as Behcet's disease, syphilis, serosanguinous spondyloarthritis and psoriatic diseases, can also lead to inflammatory responses in the uvea (19).…”

Real-world treatment patterns for repository corticotropin injection in patients with rheumatoid arthritis

“…The treatment patterns identified in our study may provide insights to improve patient care and help better understand practices for RCI use in RA. Similar real-world effectiveness studies have reported positive clinical outcomes after initiating RCI treatment in patients with refractory diseases, including multiple sclerosis, 40 , 47 sarcoidosis, 12 uveitis, 41 nephrotic syndrome, 48 systemic lupus erythematosus, and dermatomyositis or polymyositis. 20 Outcomes of these studies align with those presented here for RA.…”

“…Treatment patterns, medical history and GC dosing are important topics that should be continually discussed by practitioners with patients. 12 , 20 , 40 , 41 Recent ACR guidelines strongly discourage long-term GC use to maintain treatment targets in patients with RA. The European League Against Rheumatism (EULAR) advises GC tapering “as rapidly as clinically possible.” 32 RCI treatment is associated with reduction of the use of concomitant medications such as GCs and DMARDs.…”

The Role of Retinal Pigment Epithelial Cells in Regulation of Macrophages/Microglial Cells in Retinal Immunobiology

“…Also, by tailoring the therapy to specific melanocortin receptors different aspects of an immune response can be targeted for regulation (116). The experimental therapeutic use of a-MSH in EAU demonstrates that it is possible to use the mechanisms of ocular immune privilege, and potentially other RPE generated molecules, to suppress inflammation and reestablish ocular immune privilege and tolerance (117,118).…”