Objectives To evaluate the effect, efficacy and side effects of a single injection of i.m. ACTH (2 mg of tetracosactide) in RA patients requiring steroid treatment.
Methods In a pilot study 11 RA patients, fulfilling the ACR criteria were treated with a single i.m. injection of 2 mg of tetracosactide (Cortrosyn depot, Organon) in an open trial. All patients were female, with the average age of 48,9 years, disease duration of 5,2 years. 4 patients have a disease duration less than one year, 5 received also 5-7,5 mg daily prednisolon treatment. None of the four patients with disease duration less than one year had any DMARD treatment, but all the others had. Patients with hypertension, diabetes, know hypersensitivity to drugs, inclination to water retention were excluded. Joint pain (VAS), number of tender and swollen joints, duration of morning stiffness and patients? global assessment were measured before the injection and on the 3rd, 7th, 14th, 21st, 28th days thereafter. CRP levels were also measured.
Results All clinical parameters and the CRP level improved significantly (p < 0,005) on the 3rd, 7th and 14th day, but on the 21st and 28th days there was no significant difference as compared with the initial values. There was no difference in respond-rate between prednisolon treated and non-treated patients. Side effects: slight elevation of blood pressure was observed in 5, water retention in 2 patients in the first 3–4 days. The side effects were considered as unacceptable in one patient having blood pressure elevation up to 170/100 Hgmm and water retention. Out of the 4 patients with disease duration less than one year, 3 patients had continued ACTH treatment by administering 2 mg-s of tetracosactide in 1–3 week?s intervals, as bridging therapy. Two other patients on DMARDs still receive ACTH injections, one of them monthly and the other bimonthly.
Conclusion ACTH treatment of RA may be reassessed, especially in young patients requiring bridging therapy or continuous steroid treatment. It may correct the slightly deficient hypothalamo-pituitary-adrenal axis in RA patients and may prevent drug-induced hypadrenia.
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