International Medical Case Reports Journal (Jun 2016)
Adrenocorticotropic hormone analog use for podocytopathies
Abstract
Edward J Filippone,1 Shirley J Dopson,2 Denise M Rivers,3 Rebeca D Monk,4 Suneel M Udani,5 Golriz Jafari,6 Solomon C Huang,6 Arafat Melhem,7 Bassim Assioun,7 Paul G Schmitz7 1Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, 2Division of Medicine, Washington Health System, Southwestern Nephrology, Inc, Washington, PA, 3Department of Medicine, University Nephrology, University of Tennessee, Knoxville, TN, 4Department of Medicine, Division of Nephrology, University of Rochester Medical Center, Rochester, NY, 5Department of Medicine, Section of Nephrology, University of Chicago, Chicago, IL, 6Division of Nephrology and Hypertension, Olive View–University of California, Los Angeles Medical Center, Sylmar, CA, 7Department of Internal Medicine, Division of Nephrology, Saint Louis University, St Louis, MO, USABackground: Adrenocorticotropic hormone is being increasingly studied for treatment of various glomerulopathies, most notably membranous nephropathy. Less data are available regarding its use in idiopathic nephrotic syndrome (INS) secondary to minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS). We report here our experience with H.P. Acthar® Gel (repository corticotropin injection) as first-line or subsequent therapy in patients with INS.Methods: Data were taken from three patients with MCD and ten patients with FSGS from around the US, who were treated with Acthar Gel as initial or subsequent therapy. Treatment was solely at the discretion of the primary nephrologist without a specific protocol. A complete response (CR) was defined as final urine protein-to-creatinine ratio <500 mg/g and a partial response (PR) as 50% decrease without rise of serum creatinine. Side effects and tolerability were noted.Results: All three patients with MCD received Acthar Gel as second-line or later immunosuppressive (IS) therapy and all responded (one CR and two PRs). Two of the ten patients with FSGS received Acthar Gel as first-line IS therapy, while the other eight had failed multiple agents. Four of the ten patients with FSGS had responses, including two CRs and two PRs. The three patients with MCD tolerated therapy well without side effects. Five patients with FSGS tolerated therapy well, while five had various steroid-like side effects, resulting in therapy discontinuation in two patients.Conclusion: Acthar Gel is a viable alternative IS agent for treatment of INS in patients intolerant or resistant to conventional therapy. More data are needed to better define its appropriate place. Keywords: nephrotic syndrome, minimal change disease, focal segmental glomerulosclerosis, adrenocorticotropic hormone, ACTH, Acthar Gel
