Have you heard of Acthar Gel, a new treatment for Multiple Sclerosis relapses? Surprise – this drug has been around for decades, originally approved in 1952. Acthar was essentially abandoned in the 1980’s when bested by methylprednisolone.
Questcor Pharmaceuticals purchased worldwide rights to Acthar from Aventis for just $100,000 in 2001. Aventis had been losing as much as $15m annually on the drug. After tweaking manufacturing, Questcor increased the price of a single vial of Acthar from $1,600 to $23,000 overnight. Prices per vial have reportedly risen as high as $50,000. A single course of treatment may cost as much as $250,000. Unsurprisingly, this has become Questcor’s flagship drug.
Acthar is created from pig pituitary glands provided by Hormel (yes, Hormel). As any good fan of MythBusters knows, pigs and humans have an awful lot in common. These pituitary glands provide a substance very similar to human ACTH (adrenocorticotropin hormone) which prompts adrenal glands to produce chemicals such as steroids. The body also creates ACTH naturally when we experience stress.
Recently my husband and I attended a very nice multi-course dinner at a local Italian restaurant while witnessing a seminar on battling relapses. Once we were there we learned that the dinner was a pitch for Acthar. A neurologist read through slides while providing jolly old anecdotes about how many of his female patients become so unbearable to be around after relapses while being treated with steroids that their husbands leave each time to stay somewhere else for a few weeks. This fear tactic is unacceptable: use our product so that you won’t be even more of a burden to your family when you are at your weakest. The crowd was, of course, largely female and the message hit home.
Many of us often feel like burdens. How many of us have already thought, or suggested, that our significant other should leave us to pursue a happier life free of Multiple Sclerosis?
The speaker fees for these events have no limit. During one break we overheard the sales rep joking with the neurologist that half their profits for that year were generated by his prescriptions alone. There is great incentive for a doctor to pander to a pharmaceutical company that will pay potentially any amount for those prescriptions.
Acthar works by causing the body to create its own steroids. How effective is it? That data really isn’t in, but it did become obsolete when compared with using steroids as treatment before the latest marketing push. Some individuals are allergic to steroids or have extreme reactions. For those individuals, Acthar may be a good option. It has not been shown to work in patients that do not respond to steroids.
You cannot use Acthar if:
- you are allergic to any ingredient in HP Acthar Gel or to pork products
- you have primary adrenocortical overactivity or underactivity
- you have recently had surgery or trauma
- you have certain skin problems (scleroderma), osteoporosis (weakened bones), a fungal infection, a herpes infection of the eye, congestive heart failure, high blood pressure, or a history of stomach ulcers
- you have recently had or are scheduled to have a smallpox vaccination
Acthar is taken at home as an intramuscular injection. Usually the dosage is 80 units per day for a week gradually increasing to 120 units per day for 2 – 3 weeks. Vials are stored in refrigeration then brought to room temperature before use. It has been approved for use in 19 conditions, including Multiple Sclerosis.
Side effects for Acthar sound very familiar to those for Solu-Medrol, etc:
- changes to appetite
- difficulty sleeping
- severe mood changes
- mood swings
- decreased vision
- blurred vision
- frequent urination
- acne or other skin problems
- swelling of the face
- swelling of the feet or lower legs
- rapid weight gain
- pain in the hips or other joints
- bone cell degeneration
- stomach pain
- elevated blood pressure
- greatly increased thirst
- menstrual irregularities
- thin, shiny skin
- hair loss
- muscle cramps
- muscle pain
- decreased ability to fight infection or illness
- allergic reaction (rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth face lips or tongue)
- injection site reaction
- sore throat
- slow wound healing
Personally, if I can avoid Acthar, I will. Most patient reports of Acthar use involve extraordinary weight gain at the least. However, more data will inevitably become available to allow us to more closely scrutinize this treatment.
Have you ever used Acthar? Would you use Acthar?