Treating ocular inflammation can be challenging, especially when inflammation continues despite standard therapy. For ophthalmologists caring for patients with difficult-to-treat disease, Acthar Gel (repository corticotropin injection) offers another option to consider.
Acthar Gel is a systemic medication with anti-inflammatory and immunomodulatory effects. It is not injected into the eye. Instead, it is administered by subcutaneous or intramuscular injection and works through several pathways that may help reduce inflammation.
A Different Approach to Inflammation
Acthar Gel is a form of corticotropin that stimulates the body’s production of corticosteroids. It also activates melanocortin receptors, which are involved in regulating inflammation and immune responses.
This activity may be particularly relevant in ocular inflammatory disease. The melanocortin system is part of the eye’s natural mechanisms for controlling inflammation, making it an area of growing interest in ophthalmology.
Where Can Acthar Gel Fit?
Acthar Gel is FDA-labeled for several inflammatory conditions involving the eye, including keratitis, iritis, iridocyclitis, uveitis, choroiditis, chorioretinitis, and optic neuritis.
In clinical practice, Acthar Gel may be considered for patients with persistent or recurrent ocular inflammation, including those who have not achieved adequate control with other therapies. It may also be an option when reducing a patient’s dependence on corticosteroids is an important treatment goal.
Uveitis has received particular attention. In a retrospective study of 91 patients with uveitis, 84% experienced improvement following treatment with Acthar Gel. Patients were also able to reduce the use of other medications in many cases. While more prospective research would be valuable, these findings add to the growing clinical experience with Acthar Gel in ocular inflammation.
Looking Beyond Traditional Treatment
One of the appealing aspects of Acthar Gel is its multimodal approach to inflammation. Rather than relying on a single mechanism, it can influence both corticosteroid production and melanocortin pathways.
For patients with complex inflammatory eye disease, having another treatment option can be valuable. The choice of therapy should always be individualized, taking into account the patient’s diagnosis, disease severity, previous treatments, and treatment goals.
The Bottom Line
Acthar Gel represents an additional tool in the ophthalmologist’s treatment toolbox. Its systemic anti-inflammatory and immunomodulatory activity may make it a useful option for selected patients with challenging ocular inflammatory disease, particularly uveitis.
As our understanding of melanocortin pathways and ocular inflammation continues to grow, Acthar Gel may have an increasingly important role in helping ophthalmologists achieve disease control while developing individualized treatment plans for their patients.