Symptomatic Sarcoidosis
Progressive pulmonary sarcoidosis patient

Man, aged 55 years, with progressive pulmonary sarcoidosis1,2

Image not of an actual patient.

Image not of an actual patient.

  • Disease duration: 13 years

Presentation and treatment history1,2

Treated with low-dose prednisone for several years; referred for worsening symptoms

Initially treated with prednisone and methotrexate

Started on adalimumab 40 mg/wk; symptoms improved

Withdrew prednisone and methotrexate

Insurance declined further coverage of adalimumab

Patient wanted to try prednisone monotherapy; reinitiated at 10 mg/d

  • Upon initiation of prednisone and methotrexate, there was continued worsening of pulmonary symptoms and chest imaging
  • After withdrawing from prednisone and methotrexate:
    • Slowly worsening fibrotic changes on CT scan
    • Reduced forced expiratory volume in the first second (FEV1)
  • After reinitiation of prednisone:
    • Dyspnea progressively increased
    • Worsening of pulmonary function and chest imaging
      • PET scan demonstrated activity in chest and abdominal nodes

With the exception of prednisone, other therapies are not approved for the treatment of symptomatic sarcoidosis.3

Treatment with Acthar Gel1,2,*

Started on Acthar Gel 80 U twice weekly

Reduced dose to Acthar Gel 40 U twice weekly

After 2 months, reduced prednisone to 5 mg/d

Acthar Gel 40 U continued for 6 months

  • Patient had anxiety for 2 to 4 hours after injection with Acthar Gel 80 U twice weekly; anxiety improved with dose reduction, but still present for 30 minutes after injection
  • Prednisone dose reduced and Acthar Gel treatment continued for 6 months
    • No significant change in chest X-ray and resolution of nodular infiltrates on high-resolution computed tomography (HRCT) scan
  • Reduced [18F]-2-fluoro-2-deoxy-D-glucose uptake on PET scan
  • Patient declined long-term treatment

Safety findings

Noted marked anxiety on the day of injection, resolved within 16 hours of injection; better with dose reduced from Acthar Gel 80 U twice weekly to 40 U twice weekly.

These results are based on a single patient and may not be fully representative of outcomes in the overall patient population. This patient was on multiple therapies. The clinical outcomes may not be solely attributable to Acthar Gel.

*Dosage and frequency should be individualized according to the medical condition, severity of the disease, and initial response of the patient.4

lnformation on duration of 80 U of Acthar Gel is unknown.

Adapted from Baughman RP, Barney JB, O'Hare L, Lower EE —Respiratory Medicine, 2016