THERAPEUTICS

Brands

• Acthar, H.P. Acthar Gel, Cosyntropin, Cortrosyn, Tetracosactide

Generic?

• Yes

Class

• Corticosteroid

Commonly Prescribed for

(FDA approved in bold)

• Treatment of infantile spasms in infants and children under 2 years of age

• Treatment of exacerbations of multiple sclerosis (MS) in adults

• Disorders and diseases: adrenal, pituitary, rheumatic, collagen, dermatological, allergic states, ophthalmic, respiratory, and edematous state

• Diagnostic testing of adrenal function

How the Drug Works

• Similar to endogenous adrenocorticotropic hormone (ACTH), it stimulates the adrenal cortex to secrete cortisol, corticosterone, aldosterone, and a number of weakly androgenic substances. Prolonged largedose administration can induce hyperplasia and hypertrophy of the adrenal cortex and continuous high output of cortisol, corticosterone, and weak androgens. Glucocorticoids have anti-inflammatory effects, modify immune responses to stimuli, and have numerous metabolic effects. The extra-adrenal effects include increased melanotropic activity, increased growth hormone secretion, and an adipokinetic effect

How Long Until It Works

• Infantile spasm: 7–12 days

• MS: days

• Diagnostic testing: 30–60 minutes

If It Works

• Complete a course of treatment. May repeat if necessary. Monitor for long-term corticosteroid-related adverse effects

If It Doesn't Work

• Infantile spasm: consider switch to vigabatrin or other AEDs. If with underlying tuberous sclerosis, may consider surgical evaluation or everolimus

• MS: if no improvement, confirm the diagnosis of relapsing-remitting MS. Start long-term disease-modifying therapy

Best Augmenting Combos for Partial Response or Treatment-Resistance

• MS: use disease-modifying treatments to reduce relapses that require corticosteroids

Tests

• Monitor blood pressure, blood glucose, body weight, and electrolytes with longterm therapy

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• Most AEs are due to immunosuppression, metabolic, or endocrine effects

Notable AEs

• General: fluid retention, potassium loss, glucose intolerance, hypertension, behavioral and mood change, increased appetite and weight gain

• Specific reactions in children < 2: increased risk of infection, cushingoid symptoms, cardiac hypertrophy, stomach upset, diarrhea, weight gain, hypertension, irritability, acne, rash