Adrenocorticotropic hormone gel in patients with refractory rheumatoid arthritis: a case series

2015 While many patients with rheumatoid arthritis respond to treatment with diseasemodifying antirheumatic drugs, some patients have refractory disease. The mechanism of action of adrenocorticotropic hormone (ACTH) gel and its direct action on melanocortin receptors is thought to result in steroid-independent anti-inflammatory and immunomodulatory effects, in addition to steroidogenic effects. ACTH gel may provide efficacy for patients who previously failed treatment with prednisone or disease-modifying antirheumatic drugs. In this case series, we report five patients with refractory rheumatoid arthritis on ACTH gel who have failed up to five previous treatments. In these patients, ACTH gel provided improvements in inflammatory markers and/or patient-reported symptoms in each case.