Abstract
PurposeThe 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.MethodsChronic 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.ResultsSixteen 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.ConclusionsRepository 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.
Highlights
Long-term treatment with anti-inflammatory drugs such as corticosteroids has been the mainstay of treatment of symptomatic pulmonary sarcoidosis [1]
A dose of 40-unit repository corticotropin (RCI) twice a week was as effective as 80-unit RCI and was better tolerated
We evaluated the effect of RCI on pulmonary function, chest imaging, and healthrelated quality of life in advanced pulmonary sarcoidosis
Summary
Long-term treatment with anti-inflammatory drugs such as corticosteroids has been the mainstay of treatment of symptomatic pulmonary sarcoidosis [1]. Significant toxicity is often encountered in patients receiving prolonged dosage [2]. In patients who have deteriorated while having their prednisone withdrawn, several alternatives have been investigated. These include oral cytotoxic agents such as methotrexate and azathioprine [3] as well as the biologic agent infliximab [4]. The use of repository corticotropin (RCI) has been found to be similar or more effective than oral corticosteroids, with less toxicity [5,6,7]. The dose of RCI and need for a loading dose in patients receiving chronic corticosteroids were unclear. Since toxicity may be dose-dependent and the drug is
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