Abstract
PurposeTo show whether subcutaneous repository corticotropin injection (RCI, Acthar® Gel, a repository corticotropin injection, can be an effective potential therapeutic agent for noninfectious retinal vasculitis.MethodsPatients with active retinal vasculitis were followed with serial ultra-wide-field fluorescein angiograms and treated with 80 units of subcutaneous repository corticotropin injection twice weekly.Results Primary outcome of 50% improvement in response level (RL) for retinal vasculitis and percent improvement in retinal vasculitis severity scoring (RVSS) by more than one quartile (25%) at week 12 was met in 15 and 16 of the 30 total eyes, respectively, including 1 eye with severe retinal vasculitis in each group. Complete resolution of retinal vasculitis was seen in seven eyes with a mean time of 17.1 weeks. Intraocular pressure elevation requiring therapy and cataract progression were noted in two and three eyes, respectively. One patient stopped medication due to side effects (injection site reaction).Conclusion Repository corticotropin injection was well-tolerated overall. Repository corticotropin injection may be an effective therapeutic agent in the treatment of noninfectious retinal vasculitis.
Highlights
The purpose of this study is to further evaluate the possible effectiveness of RCI in treating patients with retinal vasculitis who may either be treatment naïve or who have failed other forms of therapy
Patients with active retinal vasculitis as a manifestation of noninfectious ocular inflammatory disease were identified during routine follow-up care and invited to participate
Exceptions for changes in concomitant medications were only made for any patient that was deemed in need of rescue therapy by the investigator at any time during the study because of continued significant active disease despite study medication use, or if there was deemed poor tolerance of the medication and the patient required additional therapy to help control inflammation – these patients were excluded from further analysis of clinical response of ocular inflammation to RCI
Summary
Retinal vasculitis (RV) represents a group of sight-threatening and typically stubborn forms. Treatment of Retinal Vasculitis with RCI; Anesi et al of ocular inflammation which may affect retinal arteries, veins, or capillaries. It can be potentially detrimental to vision by way of occlusive or nonocclusive mechanisms, leading to secondary unilateral or bilateral findings of retinal ischemia, macular edema, neovascular changes, retinal detachment, vitreous hemorrhage, and secondary glaucoma.[1, 2] Noninfectious RV may present alone or as a manifestation of or an association with a wide variety of other ocular inflammatory diseases like idiopathic intermediate, posterior, and panuveitis or even potentially severe systemic conditions such as sarcoidosis and AdamantiadesBehçet’s disease.[1, 3]
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