|
| Study | N | Study protocol | Mean initial lab values | Study outcome | Complications |
|
| Membranous nephropathy (MN) |
|
| Berg et al. [8] | 14 | Synthetic ACTH: 1.6 mg/wk for 2 months | SCr: 1.5 mg/dL
SrA: 2.3 g/dL·eGFR: 43 mL/min/1.73 m2
proteinuria: 4.8 g/day | 1 complete response; 13 partial responses | No serious adverse side effects |
| Ponticelli et al. [14] | 10 | Synthetic ACTH: 2 mg/wk for 12 months vs alternating methylprednisolone/cyclophosphamide every month | Proteinuria: 6 g/day | Proteinuria: 0.03 g/day 8 complete remissions; 6 partial responses | Leukopenia (n = 2) |
| Lorusso et al. [15] | 9 | Synthetic ACTH: 1 mg/wk for 12 months | SrA: 3.21 g/dL
proteinuria: 5.3 g/day | SrA: 3.83 g/dL
proteinuria: 1.52 g/day
4 complete remissions | N/A |
| Van De Logt et al. [16] | 11 | Synthetic ACTH: 2 mg/wk for 9 months | SCr: 104 μmol/L
SrA: 22 +/− 6.9 g/L
eGFR: 62 mL/min/1.73 m2
proteinuria: 8.7 mg/d | eGFR: 72 mL/min/1.73m2
proteinuria: 2 mg/d
4 complete ones
7 partial responses | Mood disorders (n = 8), increasing edema (n = 11), myalgia (n = 7), fever/infection (n = 9), hyperpigmentation skin (n = 8), hypokalemia (n = 4), cushingoid face (n = 4) |
| Picardi et al. [17] | 7 | Synthetic ACTH: 2 mg/wk for 12 months | N/A | 5 complete responses | N/A |
| Berg and Arnadottir [7] | 10 | Synthetic ACTH: 1 mg/wk or dose based on body weight (0.5–1 mg once a week or 0.75–1 mg twice a week) | SCr: 1.2 mg/dL
proteinuria: 8.38 g/day | Proteinuria: 4.58 g/day
1 complete response
1 partial response | None |
| Rauen et al. [18] | 4 | Synthetic ACTH: 0.25–2.25 mg/wk | eGFR: 40.2 mL/min/1.73 m2
proteinuria: 11.2 g/day | 2 complete responses
2 partial responses | (n = 1) weight gain, elevated blood pressure, and hyperglycemia |
| Hladunewich et al. [19] | 20 | Acthar gel: 40 or 80 units/wk | Proteinuria: 9068 ± 3384 mg/day
SrA: 2.72 ± 0.83 g/dl | Proteinuria: 3866 ± 4243 mg/day
SrA: 3.25 ± 0.60 g/dL
2 complete remissions
10 partial remissions | Cushingoid appearance (n = 3) |
| Chart study [20] | 60 | Double blind randomized trial. Patients either received 40 units 5x a week or 80 units 2x a week | N/A | 1 partial remission in 40 U arm; 5 partial remissions in 80-unit arm and 2 partial ones in combined placebo | Pneumonia (n = 2) generalized edema (n = 1) drug hypersensitivity (n = 1) |
| Madan et al. [2] | 11 | Acthar gel: 80 units twice weekly for 6 months | SrA:1.73–3.9 g/dl
SCr: 0.9–4.8 mg/dl
Proteinuria: 2500–9306 mg/d (median: 5000) | 61.1% change in proteinuria levels
4 complete remissions
2 partial remissions | 1 early termination due to fatigue and dizziness |
| Bomback et al. [5] | 11 | Acthar gel: 160 units/week for 6 months | Proteinuria: 6827 mg/day | Proteinuria: 2852 mg/day
3 complete remissions
6 partial remissions | n = 2, hyperglycemia
n = 1, bone
demineralization
n = 1, weight gain |
| Bomback et al. [4] | 5 | Subcutaneous acthar gel 40 units BIW for 2 week then 80 units BIW for 24 weeks | Proteinuria: 5.65 mg/g
SCr: 1.7–2.9 mg/dl
SrA: 2.1–4.1 g/dl | Proteinuria: 4.42 mg/g
SCr: 1.2–1.9 mg/dl
2 partial remissions | n = 2, worsened glycemic control
n = 1, increase in skin pigmentation |
|
