title: Repository corticotropin for Chronic Pulmonary Sarcoidosis.
abstract: The dose of repository corticotropin (RCI) and need for a loading dose in sarcoidosis patients receiving chronic corticosteroids are unclear. We performed a single-blind prospective study, comparing two doses of RCI in sarcoidosis.
  
  
  
  Chronic pulmonary sarcoidosis patients receiving prednisone therapy with deterioration by 5% in FVC in the previous year were studied. RCI was administered subcutaneously at a loading dose of 80 units RCI for 10 days. Patients were randomized at day 14 to receive either 40- or 80-unit RCI twice a week. The dose of prednisone was modified by the clinician who was blinded to the patient's dosage of RCI.
  
  
  
  Sixteen patients completed the full 24 weeks of the study. At week 24, there was a decrease in the dose of prednisone, and improvements in DLCO, King's Sarcoidosis Questionnaire health status and fatigue score. There was no significant change in FVC % predicted. For the PET scan, there was a significant fall in the standard uptake value (SUV) of the lung lesions. Only 3/8 patients remained on 80 units RCI for full 24 weeks. There was no significant difference in the response to therapy for those treated with 40- versus 80-unit RCI.
  
  
  
  Repository corticotropin treatment was prednisone-sparing and associated with significant improvement in DLCO, PET scan, and patient-reported outcome measures. A dose of 40-unit RCI twice a week was as effective as 80-unit RCI and was better tolerated.
authors.affiliation: Department of Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH, 45267, USA. bob.baughman@uc.edu.
authors.forename: Robert P
authors.identifier: 0000-0003-4871-3862
authors.initials: RP
authors.lastname: Baughman
authors.affiliation: Department of Medicine, University of Illinois Chicago, Chicago, IL, USA.
authors.forename: Nadera
authors.initials: N
authors.lastname: Sweiss
authors.affiliation: Department of Nuclear Medicine, St. Antonius Ziekenhuis Nieuwegein, Nieuwegein, The Netherlands.
authors.forename: Ruth
authors.initials: R
authors.lastname: Keijsers
authors.affiliation: Division of Asthma, Allergy and Lung Biology, King's College London, King's Health Partners, London, UK.
authors.forename: Surinder S
authors.initials: SS
authors.lastname: Birring
authors.affiliation: Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Shipley
authors.affiliation: Department of Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Lesley Ann
authors.initials: LA
authors.lastname: Saketkoo
authors.affiliation: Department of Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH, 45267, USA.
authors.forename: Elyse E
authors.initials: EE
authors.lastname: Lower
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006304:Health Status; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011241:Prednisone / Q000008:administration & dosage; D011446:Prospective Studies; D011653:Pulmonary Diffusing Capacity; D020127:Recovery of Function; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014797:Vital Capacity; D000070857:Walk Test
chemical_list: D005938:Glucocorticoids; D000324:Adrenocorticotropic Hormone; D011241:Prednisone
keywords: Acthar gel; PET scan; Quality of life; Repository corticotrophin; Sarcoidosis