Repository corticotropin for Chronic Pulmonary Sarcoidosis

Lung. 2017 Jun;195(3):313-322. doi: 10.1007/s00408-017-9994-4. Epub 2017 Mar 28.


Purpose: The dose of repository corticotropin (RCI) and need for a loading dose in sarcoidosis patients receiving chronic corticosteroids are unclear. We performed a single-blind prospective study, comparing two doses of RCI in sarcoidosis.

Methods: Chronic pulmonary sarcoidosis patients receiving prednisone therapy with deterioration by 5% in FVC in the previous year were studied. RCI was administered subcutaneously at a loading dose of 80 units RCI for 10 days. Patients were randomized at day 14 to receive either 40- or 80-unit RCI twice a week. The dose of prednisone was modified by the clinician who was blinded to the patient's dosage of RCI.

Results: Sixteen patients completed the full 24 weeks of the study. At week 24, there was a decrease in the dose of prednisone, and improvements in DLCO, King's Sarcoidosis Questionnaire health status and fatigue score. There was no significant change in FVC % predicted. For the PET scan, there was a significant fall in the standard uptake value (SUV) of the lung lesions. Only 3/8 patients remained on 80 units RCI for full 24 weeks. There was no significant difference in the response to therapy for those treated with 40- versus 80-unit RCI.

Conclusions: Repository corticotropin treatment was prednisone-sparing and associated with significant improvement in DLCO, PET scan, and patient-reported outcome measures. A dose of 40-unit RCI twice a week was as effective as 80-unit RCI and was better tolerated.

Trial registration: NCT02188017.

Keywords: Acthar gel; PET scan; Quality of life; Repository corticotrophin; Sarcoidosis.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adrenocorticotropic Hormone / administration & dosage*
  • Adrenocorticotropic Hormone / adverse effects
  • Adult
  • Aged
  • Chronic Disease
  • Drug Therapy, Combination
  • Female
  • Glucocorticoids / administration & dosage
  • Health Status
  • Humans
  • Lung / diagnostic imaging
  • Lung / drug effects*
  • Lung / pathology
  • Lung / physiopathology
  • Male
  • Middle Aged
  • Positron-Emission Tomography
  • Prednisone / administration & dosage
  • Prospective Studies
  • Pulmonary Diffusing Capacity
  • Recovery of Function
  • Sarcoidosis, Pulmonary / diagnosis
  • Sarcoidosis, Pulmonary / drug therapy*
  • Sarcoidosis, Pulmonary / physiopathology
  • Single-Blind Method
  • Surveys and Questionnaires
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vital Capacity
  • Walk Test


  • Glucocorticoids
  • Adrenocorticotropic Hormone
  • Prednisone

Associated data