Article: Treatment of Resistant Glomerular Diseases with Adrenocorticotropic Hormone Gel: A Prospective Trial
American Journal of Nephrology
2012 Volume 36, Issue 1, Page(s) 58–67
Abstract: Background: Adrenocorticotropic hormone (ACTH) has shown promising results in glomerular diseases resistant to conventional therapies, but the reported data have solely been from retrospective, observational studies. Methods: In this prospective, open- ... ...
Institution | Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, N.Y., and Section of Nephrology, Department of Medicine, Boston University School of Medicine, Boston, Mass., USA |
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Abstract | Background: Adrenocorticotropic hormone (ACTH) has shown promising results in glomerular diseases resistant to conventional therapies, but the reported data have solely been from retrospective, observational studies. Methods: In this prospective, open-label study (NCT01129284), 15 subjects with resistant glomerular diseases were treated with ACTH gel (80 units subcutaneously twice weekly) for 6 months. Resistant membranous nephropathy (MN), minimal change disease (MCD), and focal segmental glomerulosclerosis (FSGS) were defined as failure to achieve sustained remission of proteinuria off immunosuppressive therapy with at least 2 treatment regimens; resistant IgA nephropathy was defined as >1 g/g urine protein:creatinine ratio despite maximally tolerated RAAS blockade. Remission was defined as stable or improved renal function with ≥50% reduction in proteinuria to <0.5 g/g (complete remission) or 0.5–3.5 g/g (partial remission). Results: The study included 5 subjects with resistant idiopathic MN, 5 subjects with resistant MCD (n = 2)/FSGS (n = 3), and 5 subjects with resistant IgA nephropathy. Two resistant MN subjects achieved partial remission on ACTH therapy, although 3 achieved immunologic remission of disease (PLA2R antibody disappeared by 4 months of therapy). One subject with resistant FSGS achieved complete remission on ACTH; one subject with resistant MCD achieved partial remission but relapsed within 4 weeks of stopping ACTH. Two subjects with resistant IgA nephropathy demonstrated >50% reductions in proteinuria while on ACTH, with proteinuria consistently <1 g/g by 6 months. Three of 15 subjects reported significant steroid-like adverse effects with ACTH, including weight gain and hyperglycemia, prompting early termination of therapy without any clinical response. Conclusions: ACTH gel is a promising treatment for resistant glomerular diseases and should be studied further in controlled trials against currently available therapies for resistant disease. |
Keywords | Focal segmental glomerulosclerosis ; Membranous nephropathy ; IgA nephropathy ; Minimal change disease |
Language | English |
Publishing date | 2012-06-19 |
Publisher | S. Karger AG |
Publishing place | Basel, Switzerland |
Document type | Article |
Note | Original Report: Patient-Oriented, Translational Research |
ZDB-ID | 604540-6 |
ISSN | 1421-9670 ; 0250-8095 |
ISSN (online) | 1421-9670 |
ISSN | 0250-8095 |
DOI | 10.1159/000339287 |
Database | Karger publisher's database |
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