Real-world treatment patterns for repository corticotropin injection in patients with rheumatoid arthritis

Article Page

Abstract

Introduction: Repository corticotropin injection (RCI, Acthar® Gel) is a naturally sourced mixture of adrenocorticotropic hormone analogues and other pituitary peptides with anti-inflammatory and immunomodulatory effects. In a recent clinical trial, RCI was safe and effective for the treatment of refractory rheumatoid arthritis (RA). This study aims to describe real-world use and outcomes of patients with RA who were prescribed RCI in clinical practice through retrospective analysis of an electronic medical record database.

Methods: Patients with RA who were prescribed RCI were identified through the ColumbusTM electronic medical record repository, representing approximately 100 rheumatology practices. Demographics, medications, comorbidities, disease histories, laboratory evaluations, clinical outcomes and patient-reported outcomes were evaluated from 12 months pre-RCI to 12 months post-RCI initiation.

Results: The RCI cohort (n=63) comprised predominantly white women, aged 54 years on average, at 6 years from RA diagnosis, with high disease activity at baseline according to Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) scores. Within the 12 months pre-RCI initiation, 87% of patients were prescribed disease-modifying antirheumatic drugs and 67% were prescribed glucocorticoids. Twelve months post- RCI initiation, glucocorticoid, opioid and non-steroidal antiinflammatory drug prescriptions decreased; disease-modifying antirheumatic drug prescriptions remained stable. Reductions in CDAI, RAPID3, physician global assessment, tender joint count, swollen joint count, and pain visual analogue scale scores were observed 12 months post-RCI initiation. Few discontinuations were due to side effects. Study limitations included small sample size and incomplete electronic medical record data.

Conclusion: These findings support the safety and effectiveness of RCI for short-term adjunctive treatment of refractory RA and provide patient-management insights from routine clinical practice.

Keywords: Acthar Gel, disease-modifying antirheumatic drugs, DMARDs, glucocorticoids, real-world evidence, repository corticotropin injection, rheumatoid arthritis.

Citation: Busch H, Wan GJ, Niewoehner J, Houston P, Su Y, Clinton C, Panaccio MP. Real-world treatment patterns for repository corticotropin injection in patients with rheumatoid arthritis. Drugs Context. 2022;11:2021-10-4. https://doi.org/10.7573/dic.2021-10-4

Contributions: All authors contributed equally to the preparation of this manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: HB is a self-employed community rheumatologist who provides consulting services for BendCare, LLC. He has received speaker fees from Amgen, Aurinia, GSK, Novartis, Mallinckrodt Pharmaceuticals, Myriad Immune, Sanofi Regeneron, and UCB. GJW and JN are employees of Mallinckrodt Pharmaceuticals. PH and MPP are paid consultants for Mallinckrodt Pharmaceuticals. YS and CC are consultants for BendCare, LLC. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2022/03/dic.2021-10-4-COI.pdf

Acknowledgements: Professional writing and editorial support were provided by MedLogix Communications, LLC, Itasca, Illinois, USA, under the direction of the authors and were funded by Mallinckrodt Pharmaceuticals.

Funding declaration: This study was funded by Mallinckrodt Pharmaceuticals.

Copyright: Copyright © 2022 Busch H, Wan GJ, Niewoehner J, Houston P, Su Y, Clinton C, Panaccio MP. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0, which allows anyone to copy, distribute and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2022 Busch H, Wan GJ, Niewoehner J, Houston P, Su Y, Clinton C, Panaccio MP. https://doi.org/10.7573/dic.2021-10-4. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/real-world-treatment-patterns-for-repository-corticotropin-injection-in-patients-with-rheumatoid-arthritis

Correspondence: George J Wan, Health Economics and Outcomes Research, Mallinckrodt Pharmaceuticals, Hampton, NJ 07921, USA. Email: george.wan@mnk.com

Provenance: Submitted; externally peer reviewed.

Submitted: 11 October 2021; Accepted: 11 February 2022; Publication date: 25 March 2022.

Drugs in Context is published by BioExcel Publishing Ltd. Registered office: Plaza Building, Lee High Road, London, England, SE13 5PT.

BioExcel Publishing Limited is registered in England Number 10038393. VAT GB 252 7720 07.

For all manuscript and submissions enquiries, contact the Editorial office editorial@drugsincontext.com

For all permissions, rights and reprints, contact David Hughes david.hughes@bioexcelpublishing.com

Download free full text PDF Supplementary Material