title: Adrenocorticotropic hormone gel in the treatment of systemic lupus erythematosus: A retrospective study of patients.
abstract: OBJECTIVE
  Acthar Gel is a long-acting formulation of adrenocorticotropic hormone (ACTH) with anti-inflammatory effects thought to be mediated in part through melanocortin receptor activation. This study was initiated to understand the role of Acthar Gel in SLE treatment in rheumatology practices.
  
  
  METHODS
  This is a retrospective case series of nine adult female patients treated with Acthar Gel for at least six months at five academic centers. Treating physicians completed a one-page questionnaire on lupus medications, disease activity, and outcomes. Clinical response was defined using SLEDAI 2K and improvement in the clinical manifestation(s) being treated.
  
  
  RESULTS
  The most common clinical SLE manifestations/indications requiring therapy with Acthar Gel were arthritis, rash, and inability to taper corticosteroids. The mean SLEDAI 2K score at baseline was 5.8 ± 5.0 (range 0-16). Six patients were concomitantly treated with corticosteroids (mean dose 18.3mg/day). All patients were on background SLE medications including immunosuppressives. Seven of nine patients had an overall improvement, with a decrease in SLEDAI 2K from 5.8 ± 5.0 at baseline to 3.5 ± 2.7 (range 0-8); four of five patients had improvement or resolution in arthritis, and one of two patients had resolution of inflammatory rash. Four patients discontinued corticosteroids and one patient tapered below 50% of the initial dose by 3 months of treatment with Acthar Gel. No adverse events were reported.
  
  
  CONCLUSIONS
  This study suggests a role for Acthar Gel as an alternative to corticosteroids in the treatment of SLE. Acthar Gel appears to be safe and well-tolerated after 6 months of treatment, with a significant reduction in disease activity.
authors.affiliation: Division of Adult Rheumatology, Columbia University Medical Center, New York, NY, 10032, USA.
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
authors.affiliation: Division of Adult Rheumatology, Columbia University Medical Center, New York, NY, 10032, USA.
authors.forename: Josh
authors.initials: J
authors.lastname: Golubovsky
authors.affiliation: Division of Pediatric Rheumatology, Columbia University Medical Center, New York, NY, 10032, USA.
authors.forename: Joyce
authors.initials: J
authors.lastname: Hui-Yuen
authors.affiliation: Division of Rheumatology, University of Rochester Medical Center, New York, NY, 14642, USA.
authors.forename: Ummara
authors.initials: U
authors.lastname: Shah
authors.affiliation: University of Nevada School of Medicine, Las Vegas, NV, 89102, USA.
authors.forename: Ewa
authors.initials: E
authors.lastname: Olech
authors.affiliation: Arthritis and Pain Center, Mary Washington Hospital, Las Vegas, NV, 89102, USA.
authors.forename: Rosalia
authors.initials: R
authors.lastname: Lomeo
authors.affiliation: Arthritis Osteoporosis and Rheumatology Associates, Sewell, NJ, 08080, USA.
authors.forename: Vijay
authors.initials: V
authors.lastname: Singh
authors.affiliation: Family Arthritis Center, Jupiter, FL, 33458, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Busch
authors.affiliation: Family Arthritis Center, Jupiter, FL, 33458, USA.
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Strandberg
authors.affiliation: Family Arthritis Center, Jupiter, FL, 33458, USA.
authors.forename: Kayla
authors.initials: K
authors.lastname: Strandberg
authors.affiliation: Family Arthritis Center, Jupiter, FL, 33458, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Horowitz
authors.affiliation: Division of Adult Rheumatology, Columbia University Medical Center, New York, NY, 10032, USA.
authors.forename: Anca
authors.initials: A
authors.lastname: Askanase
keywords: ACTH; Acthar Gel; SLE; Systemic Lupus Erythematosus; lupus treatment; steroid-sparing agent