What is Acthar gel? What is it used for?
Acthar gel (repository corticotropin) is a purified preparation of ACTH extracted from slaughtered pigs’ pituitary glands. It is in a gel form designed to provide extended release of ACTH following injection. ACTH stimulates the adrenal cortex gland to secrete cortisol, corticosterone, and aldosterone. In addition, it is postulated to have other substances (e.g., melanocortins) from the pig’s pituitary that have additional immunomodulatory effects above that of just ACTH alone. However, the substances responsible for these additional effects are unclear. Acthar gel is Food and Drug administration (FDA)-approved for the treatment of various autoimmune diseases (dermatomyositis/polymyositis, SLE, nephrotic syndrome, acute exacerbation of multiple sclerosis, sarcoidosis, inflammatory eye disease, Stevens–Johnson syndrome, others) as well as for infantile spasms. The dose varies depending on the disease being treated (80 units IM daily to 80 units IM twice a week). Acthar gel is supplied in 5 mL multidose vials (80 USP units/mL). It is extremely expensive (each vial costs $40,000) because of its orphan drug status for treating infantile spasms, which is a rare disease.