Acthar Gel

Reviewed by: HU Medical Review Board | Last reviewed: May 2022 | Last updated: June 2022

Acthar Gel is an analog of adrenocorticotropic hormone (ACTH) that is used for the treatment of lupus flares and general lupus maintenance. An analog is a drug that is designed to mimic the effects of a naturally occurring substance in the body.

How is Acthar Gel used for lupus?

Acthar Gel is injected into a muscle or under the skin. It is also used for the treatment of other conditions, including multiple sclerosis, infantile spasms, and various other autoimmune, eye, skin, respiratory, and allergic conditions. It can be used with or without other medications for the treatment of lupus.

What are the ingredients in Acthar Gel?

The main ingredient in Acthar Gel is the ACTH analog, also known as repository corticotropin.

How does Acthar Gel work?

Acthar Gel is an analog of ACTH. This means it acts in the same manner as ACTH within the body. ACTH is a signaling hormone made in the brain. It travels to the adrenal glands on top of the kidneys and increases the production of other hormones, including cortisol, corticosterone, and aldosterone. These hormones play a role in the inflammatory response, including potentially reducing inflammation. This may help control or reduce lupus-related symptoms and damage.

What are the possible side effects of Acthar Gel?

The most common side effects of Acthar Gel include, but are not limited to, the following:

  • Increase in blood pressure
  • Fluid retention or swelling
  • Mood or behavior changes
  • Increased appetite
  • Weight gain
  • Changes in the way your body responds to glucose

Since Acthar Gel mimics ACTH and leads to the production of cortisol, many of its side effects are the same as those of corticosteroid drugs. These are not all the possible side effects of Acthar Gel. Patients should talk to their doctor about what to expect with treatment.

What to know about Acthar Gel

People taking Acthar Gel should not receive certain vaccines, including live or live-attenuated vaccines while taking the drug.

Some people should not take Acthar Gel

Acthar Gel should not be taken by people with the following conditions:

  • Systemic fungal infections
  • Osteoporosis (thinning of the bones)
  • Scleroderma
  • Stomach ulcers
  • Uncontrolled high blood pressure
  • Congestive heart failure
  • Ocular herpes simplex
  • Sensitivity to certain protein products (including porcine proteins)
  • Adrenocortical hyperfunction or insufficiency (issues with the adrenal glands)

Increased risks

People taking Acthar Gel may have an increased risk of infections or reactivating latent (old) infections. People taking Acthar Gel should avoid others who are sick whenever possible and practice good infection prevention, including regular handwashing. Signs of infection include, but are not limited to:

  • Fever
  • Cough
  • Diarrhea
  • Vomiting
  • Chills
  • Body aches

Long-term treatment of Acthar Gel

Long-term treatment with Acthar Gel may impact the body’s normal regulation of hormones. Do not stop taking Acthar Gel or change your dose without first talking with your doctor. Signs of a hormonal disruption related to Acthar Gel include:

  • Weight loss
  • Decreased appetite
  • Pale skin
  • Stomach pain or changes in bathroom habits
  • Weakness
  • Fatigue
  • Fever
  • An overall feeling of being ill

Other side effects

Since Acthar Gel mimics a hormone that increases cortisol, it can cause or worsen corticosteroid-related side effects. People taking Acthar Gel should be monitored for Cushing’s Syndrome (too much cortisol). Common signs of Cushing’s syndrome include, but are not limited to:

  • Rounded, puffy face
  • Thin skin with easy bruising
  • Stretch marks on stomach, arms, thighs, or other areas
  • Weight gain
  • Increased body fat around the neck
  • Weak bones
  • High blood pressure

Continued monitoring

People on Acthar Gel should also be monitored for high blood pressure, low potassium levels, behavior or mood changes, and decreases in bone density (strength). Acthar Gel may increase a person’s risk of developing eye issues or gastrointestinal ulcers. People with conditions like myasthenia gravis, diabetes, thyroid issues, or liver cirrhosis may experience a worsening of these conditions while taking Acthar Gel. Acthar Gel may impact a developing fetus. Women who are pregnant or planning to become pregnant should talk to their doctor before taking Acthar Gel.

Talk to your healthcare provider

Before starting Acthar Gel, tell your doctor if you have/had any of the following:

  • Diabetes
  • Heart, kidney, thyroid, stomach, or liver problems
  • Recent infection
  • Recent surgery
  • Recent vaccination or a family member who is receiving a vaccination
  • History of an allergic reaction to a medication
  • Neuromuscular conditions or a history of seizures
  • Been exposed to someone with Tuberculosis (TB)
  • Are taking any other medications, including medications called diuretics
  • Are currently pregnant or planning to become pregnant

A doctor or healthcare provider can help determine if Acthar Gel is appropriate for you to use based on your current and past medical history.

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