The study aims to evaluate the potential role of ACTH gel in the management of non-infectious uveitis.
Uveitis is a term used to describe a group of inflammatory disorders involving the uveal tract (iris, ciliary body and choroid). It is amongst the most common causes in the list of preventable cause of blindness in the developed world. H.P. Acthar Gel is a highly purified sterile preparation of the adrenocorticotropic hormone (ACTH) gelatin to provide a prolonged release after intramuscular or subcutaneous (SC) injection. ACTH is part of a group of molecules called melanocortins (MC) (ACTH, α, β, γ-MSH) that are produced, in human bodies, by breakdown of a common larger precursor called proopiomelanocortin (POMC). A very well-known anti-inflammatory mechanism of action of ACTH is the production glucocorticoids by stimulating the adrenal glands. ACTH has also been shown to bind with all five melanocortin receptors (MCRs). MCRs have a variety of roles including cortisol production and regulation of immune modulation by ACTH. ACTHAR is an open-label, multi-center, randomized, phase II study to evaluate the effect of two dose regimens of repeated SC injections of ACTH gel in patients with active non-infectious intermediate, posterior, or pan-uveitis followed over a period of 12 months. ACTHAR study will be conducted at up to 7 clinical sites in USA. The study will be coordinated by the Ocular Imaging Research and Reading Center (OIRRC), which will serve as the coordinating and reading center for the ACTHAR Study. The primary endpoint of the study will be at month 6, with an active, as-needed treatment extension phase from month 6 to month 12. Thirty-six (36) patients with non-infectious intermediate, posterior, or pan-uveitis will be enrolled and randomized (1:1) to one of the two treatment arms: 1. Mandatory twice a week (Mondays and Thursdays) treatment with SC ACTH gel 80 U/day starting at BL until month 6. Starting at month 6, the treatment will be administered on as needed basis, based on the retreatment criteria. 2. Mandatory thrice a week (Mondays, Wednesdays, and Fridays) treatment with SC ACTH gel 80 U/day starting at BL until month 6. Starting at month 6, the treatment will be administered on as needed basis, based on the retreatment criteria. Starting at month 6, retreatment will be offered to study subjects who have demonstrated any level of response during the first 6 months and who meet any of these Retreatment Criteria listed below. Patients receiving retreatment will receive the dose that was assigned to them at randomization.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
28
Starting at month 6, retreatment will be offered to study subjects who have demonstrated any level of response during the first 6 months and who meet any of these Retreatment Criteria listed below. Patients receiving retreatment will receive the dose that was assigned to them at randomization.
Retina Vitreous Associates, Medical Group
Los Angeles, California, United States
Stanford University
Palo Alto, California, United States
Metropolitan Eye Research and surgery Institute
Waltham, Massachusetts, United States
Retina Centers Professional Corporation - RCPC
Cleveland, Ohio, United States
Incidence of ocular adverse events (AEs)
The incidence and severity of ocular adverse events, as identified by eye examination.
Time frame: Month 6
Incidence of systemic adverse events (AEs)
The incidence and severity of systemic adverse events.
Time frame: Month 6
Mean change from Baseline (BL) in vitreous haze (VH)
Mean change from BL in vitreous haze using the Standardization of Uveitis Nomenclature (SUN) scale.
Time frame: Month 6
Proportion of patients achieving a ≥ 1 and ≥ 2 step improvement or resolution of VH
The proportion of patients achieving a ≥ 1 and ≥ 2 step improvement or resolution of VH on SUN scale after therapy or at time of rescue.
Time frame: Month 3, 6, 12
Mean change from BL in graded anterior chamber cells
Mean change from BL in graded anterior chamber cells after therapy or at time of rescue.
Time frame: Month 3, 6, 12
Mean change from BL in Best Corrected Visual Acuity (BCVA)
Mean change from BL in BCVA using the ETDRS
Time frame: Month 3, 6, 12
Mean change in degree of inflammation
Mean change in degree of intermediate uveitis, retinal vasculitis, chorioretinitis, or other types of inflammation as documented at baseline compared to evaluation at month 6 and 12 after therapy or at time of rescue.
Time frame: Month 3, 6, 12
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Retina Consultants of Houston
Bellaire, Texas, United States
Texas Retina Assiciates
Dallas, Texas, United States
TExas Retina Associates
Dallas, Texas, United States
Mean change in leakage of disc.
Mean change in leakage of disc
Time frame: Month 3,6, 12
Change from Baseline in macular thickness
Change from Baseline in macular thickness as measured by Spectral Domain Optical Coherence Tomography (SD-OCT).
Time frame: Month 3, 6, 12
The proportion of patients who achieve a complete response in the study eye and discontinue prednisone.
The proportion of patients who achieve a complete response in the study eye and discontinue prednisone.
Time frame: Month 3, 6, 12
The proportion of patients who achieve a partial response in the study eye and discontinue prednisone.
The proportion of patients who achieve a partial response in the study eye and discontinue prednisone.
Time frame: Month 3, 6, 12
Proportion of patients achieving a ≥ 1 and ≥ 2 step improvement or resolution of VH
The proportion of patients achieving a ≥ 1 and ≥ 2 step improvement or resolution of VH on SUN scale after therapy or at time of rescue.
Time frame: Month 12
Mean change from BL in graded vitreous cells
Mean change from BL in graded vitreous cells after therapy or at time of rescue.
Time frame: Month 3, 6, 12
Mean change from BL in aqueous flare
Mean change from BL in aqueous flare as measured by aqueous flare meter.
Time frame: Month 3, 6 12
Mean change in leakage of vasculature
Mean change in leakage of vasculature
Time frame: Month 3,6, 12
Mean change in leakage of chorioretinal lesions
Mean change in leakage of chorioretinal lesions
Time frame: Month 3, 6, 12
Mean change in Leakage in Macula
Mean change in Leakage in Macula
Time frame: Month 3, 6, 12
Changes in OCTA
Changes in OCTA at various time points
Time frame: Months 3, 6, 12