ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Corticotropin injection gel: Drug information

Corticotropin injection gel: Drug information
(For additional information see "Corticotropin injection gel: Patient drug information" and see "Corticotropin injection gel: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Acthar;
  • Cortrophin
Brand Names: Canada
  • ACTH 40 [DSC]
Pharmacologic Category
  • Adrenocorticotropin Stimulating Hormone
Dosing: Adult

Note: Indication-specific dosing is not provided in the manufacturer's labeling for most labeled uses. Individualize dosage and frequency based on the severity of the disease and the initial response of the patient. Sudden withdrawal may lead to adrenal insufficiency or recurrent symptoms; tapering the dose and increasing the injection interval prior to discontinuation may be necessary following prolonged administration.

Usual dosage range :

Note: Generally used as an adjunctive agent in patients whose disease is refractory to conventional treatments. Because maximal adrenal stimulation may not occur in the first few days of treatment, other therapies should be initiated when an immediate effect is needed.

IM, SUBQ: 40 to 80 units every 24 to 72 hours.

Indication-specific dosing:

Multiple sclerosis, acute exacerbation

Multiple sclerosis, acute exacerbation (alternative therapy):

Note: Treatment guidelines recommend the use of high dose IV or oral methylprednisolone for acute exacerbations of multiple sclerosis (AAN [Scott 2011]; NICE 2014). Corticotropin may be an alternative therapy if IV corticosteroids cannot be administered or are not tolerated (Simsarian 2011).

IM, SUBQ: 80 to 120 units/day for 2 to 3 weeks.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in manufacturer's labeling; use with caution.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in manufacturer's labeling; use with caution in cirrhosis.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Corticotropin injection gel: Pediatric drug information")

Note: Sudden withdrawal may lead to adrenal insufficiency or recurrent symptoms; tapering the dose prior to discontinuation of therapy may be necessary following prolonged administration.

Infantile spasms

Infantile spasms:

Note: Expert consensus guidelines based on currently available evidence show that corticotropin (ACTH) appears to be more effective than oral corticosteroids or vigabatrin (monotherapy) for the treatment of infantile spasms in most patients and is used most frequently for initial management of infantile spasms. For patients with tuberous sclerosis complex, corticotropin may be used for non-responders to vigabatrin therapy (AAN [Go 2012]; ILAE [Wilmshurst 2015]; Knupp 2016).

Although various dosing regimens (primarily high-dose and moderate/low-dose) have been described in the literature, an optimal dosing regimen has not been defined (AAN [Go 2012]; Hancock 2013; Pellock 2010; Mackay 2004). With the high-dose regimen, initial efficacy response rates of 86% to 93% during the respective study periods have been reported (Baram 1996; Snead 1989); however, a randomized, comparative trial did not show the high-dose superior to low-dose ACTH; however, hypertension occurred more frequently in the high-dose group (Hrachovy 1994). Guidelines suggest consideration for low-dose ACTH regimens (as an alternative to high-dose); however, literature also suggests that the two dosing regimens are probably equally effective for short-term treatment (AAN [Go 2012]). A US consensus report recommends short duration of high-dose (~2 weeks), followed by a taper (Pellock 2010). In clinical practice, high-dose ACTH is used more often by neurologists than low-dose protocols (Mytinger 2012). In the US market, Acthar gel has FDA approval for treatment of infantile spasm in patients <2 years of age; however, trials may have been conducted with other corticotropin repository gel products in other countries.

Infants and Children <2 years:

High dose: Body-surface area (BSA) directed dosing: IM: 75 units/m2/dose twice daily or 150 units/m2/dose once daily for 2 weeks, followed by a 2-week taper: 30 units/m2/dose once daily in the morning for 3 days, followed by 15 units/m2/dose once daily in the morning for 3 days, followed by 10 units/m2/dose once daily in the morning for 3 days and 10 units/m2/dose every other morning for 6 days (Hodgeman 2016; Acthar manufacturer's labeling). In practice, some centers have used maximum doses of 80 units/dose twice daily or 160 units/dose once daily based on currently available dosage forms.

Low dose: Fixed dosing: IM: Initial: 20 units/day for 2 weeks; if patient responds, taper and discontinue over a 1-week period; if patient does not respond, increase dose to 30 units/day for 4 weeks then taper and discontinue over a 1-week period. Dosing based on a prospective, single-blind study which reported no major difference in effectiveness between high-dose long-duration versus low-dose short-duration ACTH therapy (Hrachovy 1994).

Anti-inflammatory or immunosuppressive

Anti-inflammatory or immunosuppressive:

Note: Although FDA approved, use has been replaced by other agents; most expert guidelines do not address corticotropin as a therapeutic option (ACR [Ringold 2013]; CAARA [Huber 2010]; KDIGO 2012):

Children >2 years and Adolescents:

Fixed dosing: Acthar: IM, SUBQ: 40 to 80 units/dose every 24 to 72 hours (manufacturer's labeling).

Weight-directed dosing: IM: 0.8 units/kg/day or 25 units/m2/day divided every 12 to 24 hours (Gal 2007).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling; use with caution.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling; use with caution in cirrhosis.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reported adverse reactions are for infants and children for infantile spasms unless otherwise noted. Other adverse events associated with corticosteroids may also occur.

>10%:

Cardiovascular: Hypertension (11%)

Infection: Infection (20%)

Nervous system: Seizure (12%)

1% to 10%:

Cardiovascular: Cardiac abnormality (cardiac hypertrophy: 3%)

Endocrine & metabolic: Drug-induced Cushing's syndrome (3%), weight gain (1%)

Gastrointestinal: Decreased appetite (3%), diarrhea (3%), vomiting (3%)

Infection: Candidiasis (≥2%)

Nervous system: Irritability (7%)

Otic: Otitis media (≥2%)

Respiratory: Nasal congestion (1%), pneumonia (≥2%), upper respiratory tract infection (≥2%)

Miscellaneous: Fever (5%)

Frequency not defined (all indications and populations):

Dermatologic: Acne vulgaris, ecchymoses, hyperpigmentation, inadvertent suppression of skin test reaction

Endocrine & metabolic: Decreased serum calcium, decreased serum potassium, growth retardation, impaired glucose tolerance/prediabetes, negative nitrogen balance, pituitary insufficiency, secondary adrenocortical insufficiency, sodium retention

Gastrointestinal: Acute peptic ulcer with hemorrhage and perforation

Hematologic & oncologic: Petechia

Immunologic: Antibody development

Nervous system: Idiopathic intracranial hypertension

Neuromuscular & skeletal: Amyotrophy, aseptic necrosis of femoral head, aseptic necrosis of humeral head, osteoporosis, pathological fracture (long bones), steroid myopathy

Ophthalmic: Exophthalmos, glaucoma, increased intraocular pressure, subcapsular posterior cataract

Miscellaneous: Wound healing impairment

Postmarketing (all indications and populations):

Cardiovascular: Atrial fibrillation, heart failure, necrotizing angiitis, palpitations, shock, subdural hematoma

Dermatologic: Diaphoresis, epidermal thinning, facial erythema

Endocrine & metabolic: Fluid retention (including peripheral swelling), hirsutism, hypokalemic alkalosis, increased serum glucose, menstrual disease

Gastrointestinal: Abdominal distention, impaired intestinal carbohydrate absorption, nausea, pancreatitis, ulcerative esophagitis

Hypersensitivity: Anaphylactic shock, anaphylaxis, hypersensitivity reaction

Infection: Abscess

Local: Injection site reaction

Nervous stem: Dizziness, fatigue, headache, insomnia, intracranial hemorrhage, lethargy, malaise, myasthenia, reversible cerebral atrophy (usually secondary to hypertension), vertigo

Neuromuscular & skeletal: Asthenia, vertebral compression fracture

Contraindications

Hypersensitivity to proteins of porcine origin; patients with scleroderma, osteoporosis, systemic fungal infections, ocular herpes simplex, peptic ulcer disease, recent surgery, congestive heart failure, uncontrolled hypertension, primary adrenocortical insufficiency, adrenocortical hyperfunction; IV administration.

Acthar gel: Additional contraindications: Children <2 years of age with suspected congenital infections; coadministration of live or live attenuated vaccines.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Warnings/Precautions

Concerns related to adverse effects:

• Adrenal suppression: May cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis. Withdrawal and discontinuation of a corticosteroid should be done slowly and carefully. Symptoms of adrenal insufficiency may be difficult to detect in infants treated for infantile spasms.

• Electrolyte disturbances: May increase retention of sodium and wasting of calcium and potassium; sodium restriction and/or potassium supplementation may be required.

• Hypersensitivity reactions: Antibodies may develop following prolonged use and increase the risk of hypersensitivity reactions.

• Immunosuppression: Prolonged use of corticosteroids may increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines. Close observation is required in patients with tuberculosis (TB) infection (latent TB) and/or TB reactivity; if therapy is prolonged, prophylaxis should be started.

• Psychiatric disturbances: Corticosteroids may cause psychiatric disturbances, including depression, euphoria, insomnia, irritability (especially in infants), mood swings, personality changes, and psychotic manifestations; effects are reversible upon discontinuation of therapy. Preexisting psychiatric conditions (eg, emotional instability, psychotic tendencies) may be exacerbated by corticosteroid use.

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with hypertension; use has been associated with fluid retention and hypertension.

• Diabetes: Use with caution in patients with diabetes mellitus; may alter glucose production/regulation leading to hyperglycemia.

• Gastrointestinal disease: Use with caution in patients with GI disease (eg, diverticulitis, ulcerative colitis, risk of impending perforation, fresh intestinal anastomoses) or abscess/pyogenic infections due to risk of gastric ulcer, GI perforation, and GI bleeding.

• Hepatic impairment: Use with caution in patients with hepatic impairment, including cirrhosis; long-term use has been associated with fluid retention.

• Myasthenia gravis: Use with caution in patients with myasthenia gravis; exacerbation of symptoms has occurred, especially during initial treatment with corticosteroids.

• Ocular disease: Use with caution in patients with cataracts and/or glaucoma; increased intraocular pressure, open-angle glaucoma, and cataracts have occurred with prolonged corticosteroid use.

• Osteoporosis: Use with caution in patients of any age at risk for osteoporosis; high doses and/or long-term use of corticosteroids have been associated with increased bone loss and osteoporotic fractures.

• Renal impairment: Use with caution in patients with renal impairment; fluid retention may occur.

• Thyroid disease: Changes in thyroid status may necessitate dosage adjustments; metabolic clearance of corticosteroids increases in patients with hyperthyroidism and decreases in patients with hypothyroidism.

Special populations:

• Pediatric: May affect growth velocity.

Concurrent drug therapy issues:

• Vaccines: For Acthar gel, concomitant use of live or live attenuated vaccines is contraindicated; use caution with inactivated vaccines (response may be variable). For Purified Cortrophin gel, avoid vaccination against smallpox; use caution with other immunization procedures.

Other warnings/precautions:

• Discontinuation of therapy: Withdraw therapy with gradual tapering of dose.

Warnings: Additional Pediatric Considerations

Use with caution in patients with osteoporosis; underlying clinical condition may also impact bone health and osteoporotic effect of corticosteroids and corticotropin in pediatric patients (Leonard 2007). Corticosteroid use may cause psychiatric disturbances, including depression, euphoria, insomnia, mood swings, personality changes, and irritability (especially in infants).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Gel, Injection:

Acthar: 80 units/mL (5 mL) [contains phenol]

Cortrophin: 80 units/mL (1 mL, 5 mL) [contains phenol]

Generic Equivalent Available: US

No

Pricing: US

Gel (Acthar Injection)

80 units/mL (per mL): $10,248.72

Gel (Cortrophin Injection)

80 units/mL (per mL): $8,394.00

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution Reconstituted, Injection:

ACTH 40: 40 units ([DSC])

Prescribing and Access Restrictions

Acthar Gel is only available through specialty pharmacy distribution and not through traditional distribution sources (eg, wholesalers, retail pharmacies). Hospitals wishing to acquire Acthar Gel should contact FFF Enterprises (1-800-843-7477).

After treatment is initiated, discharge or outpatient prescriptions should be submitted to the Acthar Support and Access Program (A.S.A.P.) in order to ensure an uninterrupted supply of the medication. The Acthar Referral/Prescription form is available online at https://actharhcp.com/acthar-patient-support/supporting-patients-and-practices/#patient-support-tabs.

Additional information is available for the A.S.A.P. at https://actharhcp.com/acthar-patient-support/access-support/.

Administration: Adult

IM, SUBQ: For IM or SUBQ use; do not administer IV. Warm gel to room temperature before administration. Do not over-pressurize vial prior to withdrawing product.

Administration: Pediatric

Parenteral: Warm gel before administration; do not over-pressurize vial when withdrawing product. May be administered IM or SubQ; IM route is recommended for the treatment of infantile spasms; do not administer IV.

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and at https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/008372s068lbl.pdf#page=18, must be dispensed with this medication.

Use: Labeled Indications

Atopic dermatitis (Purified Cortrophin): Treatment of atopic dermatitis.

Note: Although FDA approved for the treatment of atopic dermatitis, available data to support use in this condition are limited and use has been replaced by other agents. Current guidelines for the management of atopic dermatitis do not include recommendations for the use of corticotropin in the treatment of this condition (AAD [Sidbury 2014]).

Collagen diseases: Treatment of exacerbations or as maintenance therapy of systemic lupus erythematosus or systemic dermatomyositis (polymyositis).

Note: Although FDA approved for the treatment of collagen diseases, available data to support use in these conditions are limited and use has been replaced by other agents. Current guidelines for the treatment of systemic lupus erythematosus (EULAR [Fanouriakis 2019]) and recent guidance on the treatment of dermatomyositis and polymyositis (McGrath 2018; Yang 2019) and juvenile dermatomyositis (Bellutti Enders 2017) do not include recommendations for the use of corticotropin in the treatment of these conditions.

Dermatologic diseases: Treatment of severe erythema multiforme, severe psoriasis (Purified Cortrophin only), or Stevens-Johnson syndrome.

Note: Although FDA approved for the treatment of dermatologic diseases, available data to support use in these conditions are limited and use has been replaced by other agents. Current guidelines for the treatment of psoriasis (AAD/NPF [Menter 2020]) and Stevens-Johnson syndrome and toxic epidermal necrolysis (BAD [Creamer 2016]) and recent guidance on the treatment of erythema multiforme (Trayes 2019) do not include recommendations for the use of corticotropin in the treatment of these conditions.

Diuresis in nephrotic syndrome: To induce a diuresis or remission of proteinuria in patients with nephrotic syndrome without uremia of the idiopathic type or due to lupus erythematosus.

Note: Although FDA approved for diuresis in nephrotic syndrome, available data to support use in these conditions are limited and use has been replaced by other agents. Current guidelines for the treatment of lupus nephritis (EULAR/ERA-EDTA [Fanouriakis 2020]) and the management of glomerular diseases (KDIGO 2021) do not include recommendations for the use of corticotropin.

Infantile spasms (Acthar gel): Treatment of infantile spasms in infants and children younger than 2 years. Note: Corticotropin is the preferred treatment in most patients (AAN [Go 2012])

Multiple sclerosis: Treatment of acute exacerbations of multiple sclerosis in adults. Note: Treatment guidelines recommend the use of high dose IV or oral methylprednisolone for acute exacerbations of multiple sclerosis (AAN [Scott 2011]; NICE 2014). Corticotropin may be an alternative therapy if IV corticosteroids cannot be administered or are not tolerated (Simsarian 2011).

Ophthalmic diseases: Treatment of severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa (eg, allergic conjunctivitis, keratitis, iritis, iridocyclitis, diffuse posterior uveitis, choroiditis, optic neuritis, chorioretinitis, anterior segment inflammation).

Note: Although FDA approved for the treatment of ophthalmic diseases, available data to support use in these conditions are limited.

Rheumatic disorders: As adjunctive therapy for acute episodes/exacerbations of psoriatic arthritis, rheumatoid arthritis, including juvenile rheumatoid arthritis (select cases may require low-dose maintenance therapy), acute gouty arthritis (Purified Cortrophin only), and/or ankylosing spondylitis.

Note: Although FDA approved for the treatment of rheumatic disorders, available data to support use in these conditions are limited and use has been replaced by other agents. Current guidelines for the treatment of psoriatic arthritis (ACR/NPF [Singh 2019]), rheumatoid arthritis (ACR [Fraenkel 2021]), juvenile idiopathic arthritis (ACR/AF [Ringold 2019]), gout (ACR [FitzGerald 2020]; EULAR [Richette 2017]), and ankylosing spondylitis (ACR/SAA/SRTN [Ward 2019]) do not include recommendations for the use of corticotropin in the treatment of these conditions.

Serum sickness: Treatment of serum sickness.

Note: Although FDA approved for the treatment of serum sickness, available data to support use in this condition are limited and use has been replaced by other agents. Available guidelines for the treatment of serum sickness do not include recommendations for the use of corticotropin (AAAAI/ACAAI 2010).

Sarcoidosis, pulmonary: Treatment of symptomatic sarcoidosis.

Note: Although FDA approved for symptomatic sarcoidosis, available data to support use in this condition are limited and use has been replaced by other agents. Current guidelines for the management of sarcoidosis suggest that corticotropin may be considered for patients in whom treatment with glucocorticoids and/or antimetabolites has failed (ERS [Baughman 2021]).

Medication Safety Issues
Sound-alike/look-alike issues:

Corticotropin may be confused with corticorelin, cosyntropin

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Abrocitinib: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Abrocitinib. Management: The use of abrocitinib in combination with other immunosuppressants is not recommended. Doses equivalent to more than 2 mg/kg or 20 mg/day of prednisone (for persons over 10 kg) administered for 2 or more weeks are considered immunosuppressive. Risk D: Consider therapy modification

Acetylcholinesterase Inhibitors: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Acetylcholinesterase Inhibitors. Increased muscular weakness may occur. Risk C: Monitor therapy

Amphotericin B: Corticosteroids (Systemic) may enhance the hypokalemic effect of Amphotericin B. Risk C: Monitor therapy

Androgens: Corticosteroids (Systemic) may enhance the fluid-retaining effect of Androgens. Risk C: Monitor therapy

Androgens: Hypertension-Associated Agents may enhance the hypertensive effect of Androgens. Risk C: Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Antithymocyte Globulin (Equine): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Antithymocyte Globulin (Equine). Specifically, these effects may be unmasked if the dose of systemic corticosteroid is reduced. Corticosteroids (Systemic) may enhance the immunosuppressive effect of Antithymocyte Globulin (Equine). Specifically, infections may occur with greater severity and/or atypical presentations. Risk C: Monitor therapy

Baricitinib: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Baricitinib. Management: The use of baricitinib in combination with potent immunosuppressants is not recommended. Doses equivalent to more than 2 mg/kg or 20 mg/day of prednisone (for persons over 10 kg) administered for 2 or more weeks are considered immunosuppressive. Risk D: Consider therapy modification

BCG Products: Corticosteroids (Systemic) may enhance the adverse/toxic effect of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of BCG Products. Risk X: Avoid combination

Brincidofovir: Corticosteroids (Systemic) may diminish the therapeutic effect of Brincidofovir. Risk C: Monitor therapy

Brivudine: May enhance the adverse/toxic effect of Corticosteroids (Systemic). Risk X: Avoid combination

Calcitriol (Systemic): Corticosteroids (Systemic) may diminish the therapeutic effect of Calcitriol (Systemic). Risk C: Monitor therapy

CAR-T Cell Immunotherapy: Corticosteroids (Systemic) may enhance the adverse/toxic effect of CAR-T Cell Immunotherapy. Specifically, the severity and duration of neurologic toxicities may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of CAR-T Cell Immunotherapy. Management: Avoid use of corticosteroids as premedication before treatment with CAR-T cell immunotherapy agents. Corticosteroids are indicated and may be required for treatment of toxicities such as cytokine release syndrome or neurologic toxicity. Risk D: Consider therapy modification

Cladribine: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Cladribine. Risk X: Avoid combination

Coccidioides immitis Skin Test: Corticosteroids (Systemic) may diminish the diagnostic effect of Coccidioides immitis Skin Test. Management: Consider discontinuing systemic corticosteroids (dosed at 2 mg/kg or 20 mg/day of prednisone (for persons over 10 kg) administered for 2 or more weeks) several weeks prior to coccidioides immitis skin antigen testing. Risk D: Consider therapy modification

Corticorelin: Corticosteroids (Systemic) may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Risk C: Monitor therapy

Cosyntropin: Corticosteroids (Systemic) may diminish the diagnostic effect of Cosyntropin. Risk C: Monitor therapy

COVID-19 Vaccine (Adenovirus Vector): Corticosteroids (Systemic) may diminish the therapeutic effect of COVID-19 Vaccine (Adenovirus Vector). Management: Administer a 2nd dose using an mRNA COVID-19 vaccine (at least 4 weeks after the primary vaccine dose) and a bivalent booster dose (at least 2 months after the additional mRNA dose or any other boosters) Risk D: Consider therapy modification

COVID-19 Vaccine (Inactivated Virus): Corticosteroids (Systemic) may diminish the therapeutic effect of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor therapy

COVID-19 Vaccine (mRNA): Corticosteroids (Systemic) may diminish the therapeutic effect of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider therapy modification

COVID-19 Vaccine (Subunit): Corticosteroids (Systemic) may diminish the therapeutic effect of COVID-19 Vaccine (Subunit). Risk C: Monitor therapy

COVID-19 Vaccine (Virus-like Particles): Corticosteroids (Systemic) may diminish the therapeutic effect of COVID-19 Vaccine (Virus-like Particles). Risk C: Monitor therapy

Deferasirox: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Risk C: Monitor therapy

Dengue Tetravalent Vaccine (Live): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Dengue Tetravalent Vaccine (Live). Risk X: Avoid combination

Denosumab: May enhance the immunosuppressive effect of Corticosteroids (Systemic). Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and systemic corticosteroids. If combined, monitor patients for signs/symptoms of serious infections. Risk D: Consider therapy modification

Desirudin: Corticosteroids (Systemic) may enhance the anticoagulant effect of Desirudin. More specifically, corticosteroids may increase hemorrhagic risk during desirudin treatment. Management: Discontinue treatment with systemic corticosteroids prior to desirudin initiation. If concomitant use cannot be avoided, monitor patients receiving these combinations closely for clinical and laboratory evidence of excessive anticoagulation. Risk D: Consider therapy modification

Desmopressin: Corticosteroids (Systemic) may enhance the hyponatremic effect of Desmopressin. Risk X: Avoid combination

Deucravacitinib: May enhance the immunosuppressive effect of Corticosteroids (Systemic). Management: The use of deucravacitinib in combination with potent immunosuppressants is not recommended. Doses equivalent to more than 2 mg/kg or 20 mg/day of prednisone (for persons over 10 kg) administered for 2 or more weeks are considered immunosuppressive. Risk D: Consider therapy modification

Estrogen Derivatives: May increase the serum concentration of Corticosteroids (Systemic). Risk C: Monitor therapy

Filgotinib: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Filgotinib. Management: Coadministration of filgotinib with systemic corticosteroids at doses equivalent to greater than 2 mg/kg or 20 mg/day of prednisone (for persons over 10 kg) administered for 2 or more weeks is not recommended. Risk D: Consider therapy modification

Gallium Ga 68 Dotatate: Corticosteroids (Systemic) may diminish the diagnostic effect of Gallium Ga 68 Dotatate. Risk C: Monitor therapy

Growth Hormone Analogs: Corticosteroids (Systemic) may diminish the therapeutic effect of Growth Hormone Analogs. Growth Hormone Analogs may decrease serum concentrations of the active metabolite(s) of Corticosteroids (Systemic). Risk C: Monitor therapy

Hyaluronidase: Corticosteroids (Systemic) may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Risk D: Consider therapy modification

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Corticosteroids (Systemic) may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Management: Carefully consider the need for corticosteroids, at doses of a prednisone-equivalent of 10 mg or more per day, during the initiation of immune checkpoint inhibitor therapy. Use of corticosteroids to treat immune related adverse events is still recommended Risk D: Consider therapy modification

Indium 111 Capromab Pendetide: Corticosteroids (Systemic) may diminish the diagnostic effect of Indium 111 Capromab Pendetide. Risk X: Avoid combination

Inebilizumab: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Inebilizumab. Risk C: Monitor therapy

Influenza Virus Vaccines: Corticosteroids (Systemic) may diminish the therapeutic effect of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiation of systemic corticosteroids at immunosuppressive doses. Influenza vaccines administered less than 14 days prior to or during such therapy should be repeated 3 months after therapy. Risk D: Consider therapy modification

Isoniazid: Corticosteroids (Systemic) may decrease the serum concentration of Isoniazid. Risk C: Monitor therapy

Leflunomide: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents, such as systemic corticosteroids. Risk D: Consider therapy modification

Licorice: May increase the serum concentration of Corticosteroids (Systemic). Risk C: Monitor therapy

Loop Diuretics: Corticosteroids (Systemic) may enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy

Lutetium Lu 177 Dotatate: Corticosteroids (Systemic) may diminish the therapeutic effect of Lutetium Lu 177 Dotatate. Management: Avoid repeated use of high-doses of corticosteroids during treatment with lutetium Lu 177 dotatate. Use of corticosteroids is still permitted for the treatment of neuroendocrine hormonal crisis. The effects of lower corticosteroid doses is unknown. Risk D: Consider therapy modification

Macimorelin: Corticosteroids (Systemic) may diminish the diagnostic effect of Macimorelin. Risk X: Avoid combination

MetyraPONE: Corticosteroids (Systemic) may diminish the diagnostic effect of MetyraPONE. Management: Consider alternatives to the use of the metyrapone test in patients taking systemic corticosteroids. Risk D: Consider therapy modification

Mifamurtide: Corticosteroids (Systemic) may diminish the therapeutic effect of Mifamurtide. Risk X: Avoid combination

MiFEPRIStone: May diminish the therapeutic effect of Corticosteroids (Systemic). MiFEPRIStone may increase the serum concentration of Corticosteroids (Systemic). Management: Avoid mifepristone in patients who require long-term corticosteroid treatment of serious illnesses or conditions (eg, for immunosuppression following transplantation). Corticosteroid effects may be reduced by mifepristone treatment. Risk X: Avoid combination

Mumps- Rubella- or Varicella-Containing Live Vaccines: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination

Nadofaragene Firadenovec: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nadofaragene Firadenovec. Specifically, the risk of disseminated adenovirus infection may be increased. Risk X: Avoid combination

Natalizumab: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Natalizumab. Risk X: Avoid combination

Neuromuscular-Blocking Agents (Nondepolarizing): May enhance the adverse neuromuscular effect of Corticosteroids (Systemic). Increased muscle weakness, possibly progressing to polyneuropathies and myopathies, may occur. Management: If concomitant therapy is required, use the lowest dose for the shortest duration to limit the risk of myopathy or neuropathy. Monitor for new onset or worsening muscle weakness, reduction or loss of deep tendon reflexes, and peripheral sensory decriments Risk D: Consider therapy modification

Nicorandil: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nicorandil. Gastrointestinal perforation has been reported in association with this combination. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective). Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Nonselective): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents (Topical): May enhance the adverse/toxic effect of Corticosteroids (Systemic). Specifically, the risk of gastrointestinal bleeding, ulceration, and perforation may be increased. Risk C: Monitor therapy

Ocrelizumab: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Ocrelizumab. Risk C: Monitor therapy

Ofatumumab: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Ofatumumab. Risk C: Monitor therapy

Pidotimod: Corticosteroids (Systemic) may diminish the therapeutic effect of Pidotimod. Risk C: Monitor therapy

Pimecrolimus: May enhance the immunosuppressive effect of Corticosteroids (Systemic). Risk X: Avoid combination

Pneumococcal Vaccines: Corticosteroids (Systemic) may diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy

Poliovirus Vaccine (Live/Trivalent/Oral): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Risk X: Avoid combination

Polymethylmethacrylate: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Polymethylmethacrylate. Specifically, the risk for hypersensitivity or implant clearance may be increased. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider therapy modification

Quinolones: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Quinolones. Specifically, the risk of tendonitis and tendon rupture may be increased. Risk C: Monitor therapy

Rabies Vaccine: Corticosteroids (Systemic) may diminish the therapeutic effect of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider therapy modification

Ritlecitinib: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Ritlecitinib. Risk X: Avoid combination

Ritodrine: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Ritodrine. Risk C: Monitor therapy

Ruxolitinib (Topical): Corticosteroids (Systemic) may enhance the immunosuppressive effect of Ruxolitinib (Topical). Risk X: Avoid combination

Salicylates: May enhance the adverse/toxic effect of Corticosteroids (Systemic). These specifically include gastrointestinal ulceration and bleeding. Corticosteroids (Systemic) may decrease the serum concentration of Salicylates. Withdrawal of corticosteroids may result in salicylate toxicity. Risk C: Monitor therapy

Sargramostim: Corticosteroids (Systemic) may enhance the therapeutic effect of Sargramostim. Specifically, corticosteroids may enhance the myeloproliferative effects of sargramostim. Risk C: Monitor therapy

Sipuleucel-T: Corticosteroids (Systemic) may diminish the therapeutic effect of Sipuleucel-T. Management: Consider reducing the dose or discontinuing immunosuppressants, such as systemic corticosteroids, prior to initiating sipuleucel-T therapy. Doses equivalent to more than 2 mg/kg or 20 mg/day of prednisone given for 2 or more weeks are immunosuppressive. Risk D: Consider therapy modification

Sodium Benzoate: Corticosteroids (Systemic) may diminish the therapeutic effect of Sodium Benzoate. Risk C: Monitor therapy

Solriamfetol: May enhance the hypertensive effect of Hypertension-Associated Agents. Risk C: Monitor therapy

Sphingosine 1-Phosphate (S1P) Receptor Modulator: May enhance the immunosuppressive effect of Corticosteroids (Systemic). Risk C: Monitor therapy

Succinylcholine: Corticosteroids (Systemic) may enhance the neuromuscular-blocking effect of Succinylcholine. Risk C: Monitor therapy

Tacrolimus (Systemic): Corticosteroids (Systemic) may decrease the serum concentration of Tacrolimus (Systemic). Conversely, when discontinuing corticosteroid therapy, tacrolimus concentrations may increase. Risk C: Monitor therapy

Tacrolimus (Topical): Corticosteroids (Systemic) may enhance the immunosuppressive effect of Tacrolimus (Topical). Risk X: Avoid combination

Talimogene Laherparepvec: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid combination

Tertomotide: Corticosteroids (Systemic) may diminish the therapeutic effect of Tertomotide. Risk X: Avoid combination

Thiazide and Thiazide-Like Diuretics: Corticosteroids (Systemic) may enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Tofacitinib: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Tofacitinib. Management: Coadministration of tofacitinib with potent immunosuppressants is not recommended. Doses equivalent to more than 2 mg/kg or 20 mg/day of prednisone (for persons over 10 kg) administered for 2 or more weeks are considered immunosuppressive. Risk D: Consider therapy modification

Typhoid Vaccine: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Typhoid Vaccine. Risk X: Avoid combination

Ublituximab: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Ublituximab. Risk C: Monitor therapy

Upadacitinib: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Upadacitinib. Management: Coadministration of upadacitinib with systemic corticosteroids at doses equivalent to greater than 2 mg/kg or 20 mg/day of prednisone (for persons over 10 kg) administered for 2 or more weeks is not recommended. Risk D: Consider therapy modification

Urea Cycle Disorder Agents: Corticosteroids (Systemic) may diminish the therapeutic effect of Urea Cycle Disorder Agents. More specifically, Corticosteroids (Systemic) may increase protein catabolism and plasma ammonia concentrations, thereby increasing the doses of Urea Cycle Disorder Agents needed to maintain these concentrations in the target range. Risk C: Monitor therapy

Vaccines (Inactivated/Non-Replicating): Corticosteroids (Systemic) may diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Administer vaccines at least 2 weeks prior to immunosuppressive corticosteroids if possible. If patients are vaccinated less than 14 days prior to or during such therapy, repeat vaccination at least 3 months after therapy if immunocompetence restored. Risk D: Consider therapy modification

Vaccines (Live): Corticosteroids (Systemic) may enhance the adverse/toxic effect of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Vaccines (Live). Management: Avoid live vaccines during and for 1 month after therapy with immunosuppressive doses of corticosteroids (equivalent to prednisone > 2 mg/kg or 20 mg/day in persons over 10 kg for at least 2 weeks). Give live vaccines prior to therapy whenever possible. Risk D: Consider therapy modification

Vitamin K Antagonists (eg, warfarin): Corticosteroids (Systemic) may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Yellow Fever Vaccine: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Yellow Fever Vaccine. Risk X: Avoid combination

Pregnancy Considerations

Endogenous corticotropin concentrations are increased near delivery (Smith 2007).

Corticotropin stimulates an endogenous steroid response; outcomes observed following systemic corticosteroid use during pregnancy may be relevant. Some studies have shown an association between first trimester systemic corticosteroid use and oral clefts; however, information is conflicting and may be influenced by maternal dose, duration/frequency of exposure, and indication for use. Additional data are needed to evaluate any potential risk of systemic corticosteroids and other adverse pregnancy outcomes (eg, gestational diabetes mellitus, low birth weight, preeclampsia, preterm birth) (ACOG 2019; Bandoli 2017; Lunghi 2010; Skuladottir 2014). Hypoadrenalism may occur in newborns following maternal use of corticosteroids in pregnancy; monitor.

Breastfeeding Considerations

It is not known if corticotropin is present in breast milk.

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother.

Dietary Considerations

May require increased dietary or supplemental intake of potassium; may require decreased dietary intake of sodium.

Monitoring Parameters

Blood pressure, cardiac function, weight; serum glucose, electrolytes; signs of adrenal insufficiency; signs of Cushing syndrome; secondary ocular infections.

Following prolonged use: Bone mass density, growth in children, signs and symptoms of infection, cataract formation.

Following discontinuation: Signs of infection, cardiac function, blood pressure, serum glucose, body weight, fecal blood.

Mechanism of Action

Stimulates the adrenal cortex to secrete adrenal steroids (including cortisol), weakly androgenic substances, and aldosterone. Prolonged administration of large doses induces hyperplasia and hypertrophy of the adrenal cortex and continuous high output of cortisol, corticosterone, and weak androgens. Trophic effects on the adrenal cortex appear to be mediated by cyclic adenosine monophosphate. Also reported to bind to melanocortin receptors.

Pharmacokinetics (Adult Data Unless Noted)

Onset: Maximum effect: Cortisol serum concentration: IM, SUBQ: 3 to 12 hours.

Duration of action: Repository: 10 to 25 hours, up to 3 days.

Absorption: IM: Over 8 to 16 hours.

Half-life elimination: ACTH: 15 minutes.

Excretion: Urine.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AR) Argentina: Acthel | Acthelea;
  • (AT) Austria: Acth;
  • (CN) China: Adrenocorticotropin | Adrenocorticotropine | Corticotrophin;
  • (JP) Japan: Acth daiichi | Acthar;
  • (PE) Peru: Acth | Acthar;
  • (PH) Philippines: Acthar;
  • (SI) Slovenia: Acth
  1. Acthar Gel (repository corticotropin injection) [prescribing information]. Bedminster, NJ: Mallinckrodt ARD LLC; October 2021.
  2. American Academy of Allergy, Asthma and Immunology (AAAAI); American College of Allergy, Asthma and Immunology (ACAAI); Joint Council of Allergy, Asthma and Immunology. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010;105(4):259-273. doi:10.1016/j.anai.2010.08.002. [PubMed 20934625]
  3. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 776: immune modulating therapies in pregnancy and lactation. Obstet Gynecol. 2019;133(4):e287-e295. doi 10.1097/AOG.0000000000003176 [PubMed 30913201]
  4. Bandoli G, Palmsten K, Forbess Smith CJ, Chambers CD. A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcomes. Rheum Dis Clin North Am. 2017;43(3):489-502. doi:10.1016/j.rdc.2017.04.013 [PubMed 28711148]
  5. Baram TZ, Mitchell WG, Tournay A, Snead OC, Hanson RA, Horton EJ. High-dose corticotropin (ACTH) versus prednisone for infantile spasms: a prospective, randomized, blinded study. Pediatrics. 1996;97(3):375-379. [PubMed 8604274]
  6. Baughman RP, Valeyre D, Korsten P, et al. ERS clinical practice guidelines on treatment of sarcoidosis. Eur Respir J. 2021;58(6):2004079. doi:10.1183/13993003.04079-2020 [PubMed 34140301]
  7. Bellutti Enders F, Bader-Meunier B, Baildam E, et al. Consensus-based recommendations for the management of juvenile dermatomyositis. Ann Rheum Dis. 2017;76(2):329-340. doi:10.1136/annrheumdis-2016-209247 [PubMed 27515057]
  8. Creamer D, Walsh SA, Dziewulski P, et al. U.K. guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016. Br J Dermatol. 2016;174(6):1194-1227. doi:10.1111/bjd.14530 [PubMed 27317286]
  9. Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736-745. doi:10.1136/annrheumdis-2019-215089 [PubMed 30926722]
  10. Fanouriakis A, Kostopoulou M, Cheema K, et al. 2019 update of the joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of lupus nephritis. Ann Rheum Dis. 2020;79(6):713-723. doi:10.1136/annrheumdis-2020-216924 [PubMed 32220834]
  11. FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care Res (Hoboken). 2020;72(6):744-760. doi:10.1002/acr.24180 [PubMed 32391934]
  12. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2021;73(7):924-939. doi:10.1002/acr.24596 [PubMed 34101387]
  13. Gal P, Reed M. Medications. In: Kliegman RM, Behrman RE, Jenson HB, et al, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007: 2955-2999.
  14. Go CY, Mackay MT, Weiss SK, et al; Child Neurology Society; American Academy of Neurology. Evidence-based guideline update: medical treatment of infantile spasms. Report of the Guideline Development Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2012;78(24):1974-1980. doi: 10.1212/WNL.0b013e318259e2cf.
  15. Haines ST and Casto DT, "Treatment of Infantile Spasms," Ann Pharmacother, 1994, 28(6):779-91. [PubMed 7919570]
  16. Hancock EC, Osborne JP, Edwards SW. Treatment of infantile spasms. Cochrane Database Syst Rev. 2013;(6):CD001770. [PubMed 23740534]
  17. Hodgeman RM, Kapur K, Paris A, et al. Effectiveness of once-daily high-dose ACTH for infantile spasms. Epilepsy Behav. 2016;59:4-8. [PubMed 27084976]
  18. Hrachovy RA and Frost JD Jr, "Infantile Spasms," Pediatr Clin North Am, 1989, 36(2):311-29. [PubMed 2538796]
  19. Hrachovy RA, Frost JD Jr, Glaze DG. High-dose, long-duration versus low-dose, short-duration corticotropin therapy for infantile spasms. J Pediatr. 1994;124(5 Pt 1):803-806. [PubMed 8176573]
  20. Hrachovy RA, Frost JD Jr, Kellaway P, et al, "Double-Blind Study of ACTH vs Prednisone Therapy in Infantile Spasms," J Pediatr, 1983, 103(4):641-5. [PubMed 6312008]
  21. Huber AM, Giannini EH, Bowyer SL, et al. Protocols for the initial treatment of moderately severe juvenile dermatomyositis: results of a Children's Arthritis and Rheumatology Research Alliance Consensus Conference. Arthritis Care Res (Hoboken). 2010;62(2):219-225. [PubMed 20191521]
  22. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021;100(4S):S1-S276. doi:10.1016/j.kint.2021.05.021 [PubMed 34556256]
  23. KDIGO. Clinical Practice Guideline for Glomerulonephritis. Kidney International Supplements. June 2012.
  24. Knupp KG, Coryell J, Nickels KC, et al. Response to treatment in a prospective national infantile spasms cohort. Ann Neurol. 2016;79(3):475-484. [PubMed 26704170]
  25. Leonard MB. Glucocorticoid-induced osteoporosis in children: impact of the underlying disease. Pediatrics. 2007;119 Suppl 2:S166-174. [PubMed 17332238]
  26. Lunghi L, Pavan B, Biondi C, et al. Use of glucocorticoids in pregnancy. Curr Pharm Des. 2010;16(32):3616-3637. doi:10.2174/138161210793797898 [PubMed 20977425]
  27. Mackay MT, Weiss SK, Adams-Webber T, et al; American Academy of Neurology; Child Neurology Society. Practice parameter: medical treatment of infantile spasms: report of the American Academy of Neurology and the Child Neurology Society. Neurology. 2004;62(10):1668-1681. [PubMed 15159460]
  28. McGrath ER, Doughty CT, Amato AA. Autoimmune myopathies: updates on evaluation and treatment. Neurotherapeutics. 2018;15(4):976-994. doi:10.1007/s13311-018-00676-2 [PubMed 30341597]
  29. Menter A, Gelfand JM, Connor C, et al. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. J Am Acad Dermatol. 2020;82(6):1445-1486. doi:10.1016/j.jaad.2020.02.044 [PubMed 32119894]
  30. Mytinger JR, Joshi S; Pediatric Epilepsy Research Consortium, Section on Infantile Spasms. The current evaluation and treatment of infantile spasms among members of the Child Neurology Society. J Child Neurol. 2012;27(10):1289-1294. [PubMed 22914371]
  31. National Institute for Health and Care Excellence (NICE). Multiple sclerosis in adults: management. NICE clinical guideline CG186. London, UK: National Institute for Health and Care Excellence; October 2014. nice.org.uk/guidance/cg186. Accessed October 7, 2016.
  32. Pellock JM, Hrachovy R, Shinnar S, et al, "Infantile Spasms: A U.S. Consensus Report," Epilepsia, 2010, 51(10):2175-89. [PubMed 20608959]
  33. Purified Cortrophin gel (repository corticotropin injection, USP) [prescribing information]. Baudette, MN: ANI Pharmaceuticals Inc; January 2022.
  34. Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29-42. doi:10.1136/annrheumdis-2016-209707 [PubMed 27457514]
  35. Ringold S, Angeles-Han ST, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for non-systemic polyarthritis, sacroiliitis, and enthesitis. Arthritis Care Res (Hoboken). 2019;71(6):717-734. doi:10.1002/acr.23870 [PubMed 31021516]
  36. Ringold S, Weiss PF, Beukelman T, et al. 2013 update of the 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: recommendations for the medical therapy of children with systemic juvenile idiopathic arthritis and tuberculosis screening among children receiving biologic medications. Arthritis Rheum. 2013;65(10):2499-2512. [PubMed 24092554]
  37. Scott TF, Frohman EM, De Seze J, Gronseth GS, Weinshenker BG; Therapeutics and Technology Assessment Subcommittee of American Academy of Neurology. Evidence-based guideline: clinical evaluation and treatment of transverse myelitis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2011;77(24):2128-2134. [PubMed 22156988] 10.1212/WNL.0b013e31823dc535
  38. Sidbury R, Davis DM, Cohen DE, et al; American Academy of Dermatology. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol. 2014;71(2):327-349. doi:10.1016/j.jaad.2014.03.030 [PubMed 24813298]
  39. Simsarian JP, Saunders C, Smith DM. Five-day regimen of intramuscular or subcutaneous self-administered adrenocorticotropic hormone gel for acute exacerbations of multiple sclerosis: a prospective, randomized, open-label pilot trial. Drug Des Devel Ther. 2011;5:381-389. doi: 10.2147/DDDT.S19331. [PubMed 21792296]
  40. Singh JA, Guyatt G, Ogdie A, et al. Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Arthritis Rheumatol. 2019;71(1):5-32. doi:10.1002/art.40726. [PubMed 30499246]
  41. Skuladottir H, Wilcox AJ, Ma C, et al. Corticosteroid use and risk of orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2014;100(6):499-506. doi:10.1002/bdra.23248 [PubMed 24777675]
  42. Smith R, “Parturition,” N Engl J Med, 2007, 356(3):271-83. [PubMed 17229954]
  43. Snead OC 3rd, Benton JW Jr, Hosey LC, et al. Treatment of infantile spasms with high-dose ACTH: efficacy and plasma levels of ACTH and cortisol. Neurology. 1989;39(8):1027-1031. [PubMed 2548119]
  44. Trayes KP, Love G, Studdiford JS. Erythema multiforme: recognition and management. Am Fam Physician. 2019;100(2):82-88. [PubMed 31305041]
  45. Ward MM, Deodhar A, Gensler LS, et al. 2019 update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis. Arthritis Care Res (Hoboken). 2019;71(10):1285-1299. doi:10.1002/acr.24025 [PubMed 31436026]
  46. Wilmshurst JM, Gaillard WD, Vinayan KP, et al. Summary of recommendations for the management of infantile seizures: Task Force Report for the ILAE Commission of Pediatrics. Epilepsia. 2015;56(8):1185-1197. [PubMed 26122601]
  47. Yang SH, Chang C, Lian ZX. Polymyositis and dermatomyositis - challenges in diagnosis and management. J Transl Autoimmun. 2019;2:100018. doi:10.1016/j.jtauto.2019.100018 [PubMed 32743506]
Topic 8885 Version 300.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟