cosyntropin and Edema

New therapeutic agents are warranted in idiopathic membranous nephropathy. Synthetic ACTH may be advantageous with reported remission rates up to 85% and few side effects. We conducted a prospective open label cohort study from 2008 till 2010 (NCT00694863). We prospectively selected patients with idiopathic membranous nephropathy and high risk for progression (defined as βeta-2-microglobulin (β2m) excretion of >500 ng/min). For comparison, we selected matched historical controls treated with cyclophosphamide. The prospectively selected patients received intramuscular injections of synthetic ACTH during 9 months (maximal dose 1 mg twice a week). The primary endpoints concerned the feasibility and incidence of remissions as a primary event. Secondary endpoints included side effects of treatment and the incidence of remissions and relapses at long-term follow-up. Twenty patients (15 men) were included (age 54±14 years, serum creatinine 104 μmol/l [IQR 90–113], urine protein:creatinine ratio 8.7 g/10 mmol creatinine [IQR 4.3–11.1]). Seventeen patients (85%) completed treatment. 97% of injections were administered correctly. Cumulative remission rate was 55% (complete remission in 4 patients, partial remission 7 patients). In a group of historical controls treated with cyclophosphamide and steroids, 19 of 20 patients (95%) developed a remission (complete remission in 13 patients, partial remission in 6 patients) (p<0.01). The main limitation of our study is its small size and the use of a historical control group. We show that treatment with intramuscular injections of synthetic ACTH is feasible. Our data suggest that synthetic ACTH is less effective than cyclophosphamide in inducing a remission in high risk patients with idiopathic membranous nephropathy. The use of synthetic ACTH was also associated with many adverse events. Therefore, we advise against synthetic ACTH as standard treatment in membranous nephropathy.

Topics: Adult; Cosyntropin; Cyclophosphamide; Edema; Feasibility Studies; Female; Follow-Up Studies; Glomerulonephritis, Membranous; Humans; Immunosuppressive Agents; Male; Middle Aged; Pilot Projects; Prospective Studies; Recurrence; Remission Induction; Risk Factors; Sleep Wake Disorders; Treatment Outcome

Synthetic adrenocorticotropic hormone (ACTH) has been demonstrated to be effective in patients with membranous nephropathy, minimal change disease and some histological subtypes of focal segmental glomerulosclerosis. Its clinical impact in patients with IgA nephropathy is currently unclear.. In this report, we describe the clinical use of ACTH in patients with IgA nephropathy. Three female patients (24-44 years) with overt proteinuria received intramuscular (IM) ACTH for varying time periods (8-14 months). Pre-treatment urine protein varied from 2.9 g/d to 4.3 g/d.. There was complete remission in one patient on ACTH monotherapy and in the other two when prescribed as a steroid-sparing agent in combination with cyclophosphamide. All three had resolution in proteinuria to less than 1 g/d and maintained their GFR to baseline values. There were no reported side effects at a once a week dose. This study illustrates that ACTH is an effective agent that is well tolerated with minimal side effects and can be used as an alternative to prednisone in patients with IgA nephropathy.

Topics: Adult; Cosyntropin; Edema; Female; Glomerulonephritis, IGA; Hormones; Humans

Topics: Adrenocorticotropic Hormone; Cortisone; Cosyntropin; Edema; Humans; Psoriasis; Retrospective Studies; Skin Diseases; Skin Diseases, Vesiculobullous

The anti-inflammatory activity of the pyrophtalone derivative, [methyl-2 (piperidino-2 ethyl-1)-1 dihydro 1-4 pyridylidene-4 yl]-2 indanedione 1-3 or PpEtgammaL is not dependent upon adrenal gland stimulation. PpEtgammaL has an inhibitory effect neither on prostaglandin release after biosynthesis nor on prostaglandin synthetase. The reduced prostaglandin production, as result of drug action can be explained by impairment of substrate availability for this enzyme. There are several hypotheses, but according to the present results of our work, the most plausible one is an inhibition of unsaturated fatty acids release from cell membrane lipids.

Topics: Adipose Tissue; Adrenalectomy; Animals; Anti-Inflammatory Agents; Cosyntropin; Edema; Female; Guinea Pigs; In Vitro Techniques; Indans; Indenes; Lung; Lysosomes; Male; Membranes; Muscle Contraction; Muscle, Smooth; Pregnancy; Prostaglandin-Endoperoxide Synthases; Prostaglandins E; Rabbits; Rats; Uterine Contraction; Vasodilation

The difficulties of long term treatment of chronic obstructive lung disease demand knowledge and use of every reasonable therapeutic regimen. In this study effectivity and side effects of Depot-ACTH (Tetracosactid) are presented. The main indications for the use of Depot-ACTH seem to be the uneffectiveness of usual therapy and the attempt of avoiding or reducing corticosteroids. The study confirms the excellent usefulness of Depot-ACTH which did not diminish during long-term application. The side effects are rare and mostly inferior. Only allergic reactions may be serious and must be accounted for.

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Aged; Asthma; Child; Cosyntropin; Diabetes Complications; Drug Hypersensitivity; Edema; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Pregnancy; Pregnancy Complications; Pulmonary Emphysema; Tuberculosis, Pulmonary