ACTH Treatment for Management of Nephrotic Syndrome: A Systematic Review and Reappraisal

Table 9

Summary of studies on ACTH in IgA nephropathy.

Study	N	Study protocol	Mean initial lab values	Study outcome	Complications
IgA nephropathy (IgAN)
Bomback et al. [5]	1	Acthar gel: 40 units twice per week for 8 months	Proteinuria: 4952 mg/day	Proteinuria: 42 mg/day; 1 complete response	None
Bomback et al. [4]	5	Acthar gel: 40 units twice per week for 2 weeks then 80 units twice per week for 6 months	SCr: 0.8–2.7 mg/dl; SrA: 3.7–4.3 g/dl; UPCR: 0.61–1.95 g/g	SCr: 0.8–2.1 mg/dl; SrA: 4.1–4.5 g/dl; UPCR: 0.21–1.22 g/g; 1 complete response; 1 partial response	n = 1 weight gain, cushingoid facies, increased blood pressure; Withdrawn due to worsening kidney function
Madan et al. [2]	5	Acthar gel: 80 units twice weekly for 6 months	SCr: 1.0–2.8 mg/dl; SrA: 3.0–2.0 g/dl; Proteinuria 2500–9306 mg/d (4268 ± 2931 mg/d)	SCr: 1.0–1.5 mg/dl; SrA: 3.6–4.2 g/dl; Proteinuria: 800–2360 mg/d (1416 ± 654 mg/d); 67.3% reduction in proteinuria; 2 partial remissions	1 early termination; (n = 1) weight gain; (n = 1) hypertension
Khastgir et al. [6]	5	Acthar gel: 80 units twice weekly for 6 months	N/A	2 partial remissions; 36.4% proteinuria reduction	1 early termination due to hypertension and weight gain
Zand et al. [24]	19	Acthar gel: 80 units twice weekly for 6 months	SCr: 1.40 ± 0.49 mg/dl; SrA: 3.79 ± 0.54 g/dl; 24 hr UP: 2635 (1230–5243) mg	SCr: 1.55 ± 0.64 mg/dl; SrA: 3.93 ± 0.39 g/dl; 24 hr UP: 1274; (344–6228) mg; 8 partial remissions	6 infections: 2 viral, 2 sinusitis, 1 pneumonia, 1 otitis media

SCr, serum creatinine; SrA, serum albumin; UP, urine protein; UPCR, urine protein creatinine ratio.