Ocular Sarcoidosis Open Label Trial of ACTHAR Gel

The Cleveland Clinic9 enrolled

Overview

Treatment with ACTHAR Gel will result in a reduction of ocular inflammation in patients with active ocular sarcoidosis that requires systemic immunosuppressant therapy (hypothesis)

The initial treatment of ocular sarcoidosis usually relies on a combination of topical glucocorticoids and oral glucocorticoids, both of which are associated with significant ocular and systemic toxicities. Steroid-sparing therapies are limited by variable and unpredictable efficacy, prolonged time until clinical response, medication intolerance, and difficulties obtaining payor approval. As a result, it is not uncommon that treating physicians must choose between excessive glucocorticoid toxicity versus poor control of ocular inflammation. Ongoing ocular inflammation, in turn, leads to eventual visual loss and occasionally blindness. There is a need for a more reliable, expeditious therapy that can be used as an alternative to glucocorticoids in sarcoidosis uveitis. Adrenocorticotropic hormone, through activation of melanocortin receptors on leukocytes, can dampen immune responses through non-glucocorticoid dependent mechanisms. The proposed study will aim to define whether there is effectiveness for ACTHAR gel in these patients, delineate an effect dosing regimen, and provide information about the safety of this approach for moderate to severe ocular sarcoidosis. ACTHAR is a 39-amino acid peptide natural form of adrenocorticotropin hormone (ACTH) that was initially approved in 1952 by the FDA. It has since been approved for 19 indications including respiratory sarcoidosis, multiple sclerosis, and infantile spasms.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Ocular Sarcoidosis Panuveitis Anterior Uveitis

Interventions

Repository Corticotropin InjectionDRUG

Treatment with ACTHAR Gel for 24 weeks * Initial treatment with 80 units daily for ten days (induction phase) * Maintenance treatment with 80 units twice weekly (maintenance phase)

Repository Corticotropin Injection -Treatment ExtensionDRUG

24 open label extension permitted in subjects who respond to treatment

Eligibility

Sex: ALLMin age: 18 YearsMax age: 99 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patient with sarcoidosis as defined by ATS/ERS/WASOG guidelines (American Thoracic Society/European Respiratory Society /World Association of Sarcoidosis and Other Granulomatous Diseases) * Any posterior, intermediate or panuveitis of sufficient severity to warrant therapy, in the opinion of the treating physician --OR-- Anterior uveitis requiring 4 or more daily applications of topical corticosteroids to maintain control of inflammation, or uncontrolled with topical therapy * Persistent disease activity (active uveitis) at the time of screening Exclusion Criteria: * Other cause for ocular inflammation * Uncontrolled diabetes, hypertension, or other contra-indication to increased dosage of glucocorticoids * Recent (less than 4 weeks) intra-ocular or intra-orbital steroid injection * Escalation of immunosuppressive medications between screening and initiation of the study medication * Severe extra-ocular sarcoidosis likely to require additional therapy (in the opinion of the investigator) * Administration of an investigational medication for sarcoidosis within 3 months, or 5 half-lives, whichever is longer * Have a history of any opportunistic infection within 6 months prior to screening * Have any history of malignancy, except fully resected cutaneous squamous cell cancer or cutaneous basal cell cancer, or cervical carcinoma in-situ with a minimum of 5 years period without recurrence * Severe other organ disease felt to be likely to lead to death within the next six months * Unable to follow the study protocol, including the requisite travel and follow-up ocular testing * Women of childbearing potential must be using adequate birth control measures (abstinence, hormonal contraceptives, intrauterine device, barrier method with spermicide, or surgical sterilization) and must agree to continue such precautions, and not become pregnant or plan a pregnancy for 6 months after receiving their last treatment with study agent. Women of childbearing potential must test negative on a serum pregnancy test at screening. * Breastfeeding women are excluded from participation

Locations (1)

Cleveland Clinical Foundation

Cleveland, Ohio, United States

Outcomes

Primary Outcomes

Percentage of Patients With Clinically Significant Improvement in Visual Acuity

The primary outcome was percentage of patients meeting at least one of the following variables 1) improved visual acuity, 2) resolution of intraocular inflammation, 3) ability to taper ocular or oral steroids by at least 50% or 4) reduction of cystoid macular edema, with no worsening of any single one and no need for additional sarcoidosis therapies at 24 weeks .

Time frame: Measured at 24 weeks

Secondary Outcomes

Percentage of Patients With Clinically Significant Improvement in the Resolution-intraocular Inflammation

Time frame: Measured at 24 weeks

Proportion of Patients Experiencing a Tapering of Ocular/Oral Steroids by at Least 50%

Time frame: Measured at 24 weeks

Proportion of Patients With a Clinically Significant Reduction-cystoid Macular Edema

Time frame: Measured at 24 weeks

Data from ClinicalTrials.gov

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