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Adrenocorticotropic hormone gel may treat focal segmental glomerulosclerosis post-kidney transplant
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Treatment of focal segmental glomerulosclerosis with adrenocorticotropic hormone gel may be a viable alternative for patients who fail to respond to therapeutic plasma exchange and rituximab after kidney transplant, according to a study published in Transplantation.
“Our report provides valuable information on the utilization of [adrenocorticotropic hormone] ACTH gel in the treatment-resistant posttransplant [focal segmental glomerulosclerosis] FSGS from two large transplant centers,” Tarek Alhamad, MD, of the division of nephrology in the department of medicine and the Transplant Epidemiology Research Collaboration at the Institute of Public Health at Washington University School of Medicine in St. Louis, Missouri, and colleagues wrote. “Our study examined the efficacy of ACTH gel after the failure of conventional therapy and found a significant reduction in the proteinuria with 10 patients achieved complete or partial remission, which is the endpoint of the study.”
Researchers conducted a retrospective analysis of the effects of adrenocorticotropic hormone gel in patients who developed focal segmental glomerulosclerosis either before or after kidney transplant at Washington University or Johns Hopkins University between April 2012 and December 2016, which involved 20 cases that did not respond to therapeutic plasma exchange and rituximab (mean age, 49 years; 70% were men; 65% were white; 38% had a previous kidney transplant). These patients were given adrenocorticotropic hormone gel 80 units subcutaneous two times a week for a minimum of 6 months.
Researchers defined complete remission as a decrease of proteinuria of 1 g/g or lower and a stable kidney function, with proteinuria measured by urine protein-to-creatinine ratio. Partial remission was defined as a decrease of proteinuria between 1 g/g and 3.5 g/g and stable kidney function. The median interquartile range of focal segmental glomerulosclerosis was 3 months post-transplant with 75% of patients receiving therapeutic plasma exchange at the time of diagnosis and 50% receiving rituximab before the start of adrenocorticotropic hormone gel.
Researchers found that, after approximately 6 months of using adrenocorticotropic hormone gel, the urine protein-to-creatinine ratio improved from a mean of 8.6 g/g to 3.3 g/g (P = .004) and that 50% of patients achieved complete or partial remission.
“Management of recurrent FSGS is challenging and often leads to poor allograft survival,” the researchers wrote. “The current practice of treating recurrent [focal segmental glomerulosclerosis] usually involves [therapeutic plasma exchange] TPE followed by rituximab with varying response and outcomes. When these measures fail, there is no consensus on the next options apart from extending the TPE until the patient returns back to dialysis. Given the limited therapies that are currently available for FSGS, there is a significant demand for other agents.” – by Melissa J. Webb
Disclosures: Alhamad reports receiving a research grant from Mallinckrodt. Please see the study for all other authors’ relevant financial disclosures.
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