Open Label Study of Acthar SQ Gel Injection in Patients With Active Anterior Uveitis
Study Details
Study Description
Brief Summary
Uveitis is an acute or chronic inflammatory condition of unknown etiology. Although uveitis often responds adequately to topical corticosteroids, there are many patients for which this treatment is either inadequate or not tolerated. A patient with inadequate response to treatment would manifest uveitis activity by slit lamp examination determination of anterior chamber cellularity. Lack of tolerance of therapy commonly manifests as ocular hypertension (greater than 21 mmHg measured by tonometry)complicating chronic topical corticosteroid administration, leading to glaucoma and permanent visual loss. Moreover, systemic corticosteroids may be required at a dose unsafe for chronic administration. In these situations, an immunosuppressive medication is often added as a "steroid-sparing" agent. If and when there is clinical response to the added immunosuppressive, the oral and/or topical corticosteroid dose can be reduced or eliminated to avoid toxicity.
There are several reasons for believing that Acthar might be beneficial in the treatment of uveitis patients. In addition to increasing adrenal production or cortisol, Acthar has another important mechanisms of action mediated by its binding of melanocortin receptors. Melanocortin down-regulates activity of B and T lymphocytes, monocytes and macrophages. In animal studies, melanocortin peptides down-regulate T helper cells, up-regulate T Regulatory cells, and decrease B lymphocyte production of B Lymphocyte Stimulator. In macrophages, there is down-regulation of IL-1, IL-2, INF gamma, TNF alpha, nitric oxide and adhesion molecules. In other cells, in addition to IL-10 upregulation (monocytes), there is down-regulation of VACM and ECAM (endothelial cells), prostaglandins (fibroblasts) and MCP-1 and RANTES (renal tubules).CNS mediation of systemic inflammation may also be down-regulated by melanocortin receptor binding by Acthar.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
Phase 4 |
Detailed Description
Patients eligible for the study will be identified by the investigators and given a copy of the consent form to read. Patients interested in enrolling will be screened and if eligible will be enrolled in the study. The screening visit and the baseline visit may occur on the same day. Patients enrolling will be instructed in self-administering Acthar 80 IU twice a week. Patients will keep an injection log which will be inspected at each visit (4, 8, and 12 weeks). Ophthalmology data will be collected at each visit and recorded on the case report form by the ophthalmology technician working with the sub-investigator at the time of each visit. Patients will come to the Center for Clinical Studies each visit for blood draw, blood pressure recording, and recording of adverse events.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: Intervention Acthar 80 IU SC twice w eek |
Drug: Acthar
Acthar 80 IU SC twice a week
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Change From Baseline in Eye With Uveitis of Anterior Chamber Cellularity Graded From 0-4 on a Likert Scale Determined by Slit Lamp Examination [Baseline and 12 weeks]
standard assessment of uveitis activity. Scores were assessed using a Likert scale using 0 to 4, higher score reflects more cellularity.
Secondary Outcome Measures
- Change in Baseline in Eye With Uveitis of Anterior Chamber Protein Graded 0-4 on a Likert Scale Determined by Slit Lamp Evaluation [Baseline and 12 weeks]
standard assessment of uveitis activity. Scores were assessed using a Likert scale using 0 to 4, higher score reflects more protein.
Eligibility Criteria
Criteria
Inclusion Criteria:
- Active anterior uveitis requiring oral and/or topical corticosteroid therapy
Exclusion Criteria:
-
Uncontrolled diabetes
-
Uncontrolled glaucoma
-
HIV infection or other infection for which corticosteroid therapy contraindicated
-
Contraindication to ACTHAR
-
Scleroderma
-
Osteoporosis
-
Ocular herpes simplex
-
Systemic fungal infection
-
Recent surgery
-
Uncontrolled hypertension
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Washington University in St. Louis | Saint Louis | Missouri | United States | 63110 |
Sponsors and Collaborators
- Washington University School of Medicine
- Mallinckrodt
Investigators
- Principal Investigator: Richard D Brasington, MD, Washington U Rheumatology
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- Acthar Uveitis Study
Study Results
Participant Flow
Recruitment Details | |
---|---|
Pre-assignment Detail |
Arm/Group Title | Acthar 80 IU |
---|---|
Arm/Group Description | Acthar 80 IU SC twice week |
Period Title: Overall Study | |
STARTED | 2 |
COMPLETED | 2 |
NOT COMPLETED | 0 |
Baseline Characteristics
Arm/Group Title | Acthar 80 IU |
---|---|
Arm/Group Description | Acthar 80 IU SC twice week |
Overall Participants | 2 |
Age (Count of Participants) | |
<=18 years |
0
0%
|
Between 18 and 65 years |
2
100%
|
>=65 years |
0
0%
|
Sex: Female, Male (Count of Participants) | |
Female |
2
100%
|
Male |
0
0%
|
Outcome Measures
Title | Change From Baseline in Eye With Uveitis of Anterior Chamber Cellularity Graded From 0-4 on a Likert Scale Determined by Slit Lamp Examination |
---|---|
Description | standard assessment of uveitis activity. Scores were assessed using a Likert scale using 0 to 4, higher score reflects more cellularity. |
Time Frame | Baseline and 12 weeks |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Acthar 80 IU |
---|---|
Arm/Group Description | Acthar 80 IU SC twice week |
Measure Participants | 2 |
Baseline |
0.5
(0.70)
|
12 Weeks |
1.25
(1.06)
|
Title | Change in Baseline in Eye With Uveitis of Anterior Chamber Protein Graded 0-4 on a Likert Scale Determined by Slit Lamp Evaluation |
---|---|
Description | standard assessment of uveitis activity. Scores were assessed using a Likert scale using 0 to 4, higher score reflects more protein. |
Time Frame | Baseline and 12 weeks |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Acthar 80 IU |
---|---|
Arm/Group Description | Acthar 80 IU SC twice week |
Measure Participants | 2 |
Baseline |
NA
(NA)
|
12 Weeks |
1.0
(1.41)
|
Adverse Events
Time Frame | ||
---|---|---|
Adverse Event Reporting Description | ||
Arm/Group Title | Acthar 80 IU | |
Arm/Group Description | Acthar 80 IU SC twice week | |
All Cause Mortality |
||
Acthar 80 IU | ||
Affected / at Risk (%) | # Events | |
Total | / (NaN) | |
Serious Adverse Events |
||
Acthar 80 IU | ||
Affected / at Risk (%) | # Events | |
Total | 0/2 (0%) | |
Other (Not Including Serious) Adverse Events |
||
Acthar 80 IU | ||
Affected / at Risk (%) | # Events | |
Total | 0/2 (0%) |
Limitations/Caveats
More Information
Certain Agreements
Principal Investigators are NOT employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
Name/Title | Richard Brasington MD |
---|---|
Organization | Washington University School of Medicine |
Phone | 314-454-7255 |
rbrasing@wustl.edu |
- Acthar Uveitis Study