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Lung. 2017 Jun;195(3):313-322. doi: 10.1007/s00408-017-9994-4. Epub 2017 Mar 28.

Repository corticotropin for Chronic Pulmonary Sarcoidosis.

Author information

1
Department of Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH, 45267, USA. bob.baughman@uc.edu.
2
Department of Medicine, University of Illinois Chicago, Chicago, IL, USA.
3
Department of Nuclear Medicine, St. Antonius Ziekenhuis Nieuwegein, Nieuwegein, The Netherlands.
4
Division of Asthma, Allergy and Lung Biology, King's College London, King's Health Partners, London, UK.
5
Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
6
Department of Medicine, Tulane University, New Orleans, LA, USA.
7
Department of Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH, 45267, USA.

Abstract

PURPOSE:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02188017.

KEYWORDS:

Acthar gel; PET scan; Quality of life; Repository corticotrophin; Sarcoidosis

PMID:
28353116
PMCID:
PMC5437201
DOI:
10.1007/s00408-017-9994-4
[Indexed for MEDLINE]
Free PMC Article

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