Repository corticotropin injections viable option in advanced sarcoidosis
Repository corticotropin injections demonstrated viability as an intervention for patients with advanced symptomatic sarcoidosis, with 95% of individuals in a recent cohort showing overall improvement.
“There is a real need for research in treatments for sarcoidosis,” Franck Rahaghi, MD, chairman of the department of pulmonary and critical care and medical director of the Advanced Lung Disease Program at Cleveland Clinic, Florida, told Healio. Rahaghi was not involved in the study. “Repository corticotropin is one of the two FDA-approved therapies for sarcoidosis, and new information on its efficacy is welcome.”
The current analysis included 302 patients aged at least 18 years with symptomatic sarcoidosis who had been treated with repository corticotropin injections in the previous 36 months, either by completing a course or receiving the injections for at least 6 months.
Extrapulmonary involvement was reported in 76% of the cohort, with 28% of those patients having complications in the skin, 25% in the joints, 22% in the heart and 22% in the eyes. Thirty-four percent of patients had involvement in two or more organs.
Patients had been treated with repository corticotropin injections for a mean duration of 32.5 weeks, with 61.6% of patients receiving ongoing injections for 6 or more months.
A higher starting dose of corticotropin was associated with a shorter duration of injection therapy, while a lower starting dose led to longer treatment, suggesting that clinicians used an individualized therapeutic approach, according to the researchers.
During the 3-month period before initiation of repository corticotropin injections, 61.3% of patients were using corticosteroids. By 3 months after injection therapy was initiated, just 12.9% of patients were using corticosteroids.
Similarly, the mean daily dose of corticosteroids decreased from 18.2 mg to 9.9 mg, while the proportion of patients receiving less than 10 mg per day of prednisone rose from 21% before corticotropin injection therapy to 47% at 3 months after initiation of the injections.
The researchers also reported on overall change in the health status of patients as assessed by physicians. Results of this analysis showed that overall status improved in 95% of the cohort, with overall symptoms improving in 73%, lung function improving in 38% and inflammation improving in 33%.
“The study is aligned with previous retrospective trials suggesting efficacy of repository corticotropin injections in advanced sarcoidosis,” Rahaghi said. “This information adds to the increasing body of data suggesting we should continue to consider alternative treatments until desired outcomes are achieved.” – by Rob Volansky
Disclosure: Rahaghi reports he is a consultant and speaker for Mallinckrodt.