Another treatment for relapse


Wynn D, Goldstick L, Bauer W, Zhao E, Tarau E, Cohen JA, Robertson D, Miller A. Results from a multicenter, randomized, double-blind, placebo-controlled study of repository corticotropin injection for multiple sclerosis relapse that did not adequately respond to corticosteroids. CNS Neurosci Ther. 2022 Jan 4. doi: 10.1111/cns.13789

Introduction: About 20%-35% of multiple sclerosis (MS) patients fail to respond to high-dose corticosteroids during a relapse. Repository corticotropin injection (RCI, Acthar® Gel) is a naturally sourced complex mixture of adrenocorticotropic hormone analogs and pituitary peptides that has anti-inflammatory and immunomodulatory effects.

Aims: The study objective was to determine the efficacy and safety of RCI in patients with MS relapse that inadequately responded to corticosteroids. This was a multicenter, double-blind, placebo-controlled study. Nonresponders to high-dose corticosteroids were randomized to receive RCI (80 U) or placebo daily for 14 days. Assessments included improvements on the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale (MSIS-29), Clinical Global Impression of Improvement (CGI-I), and adverse events (AEs).

Results: Eighteen patients received RCI, and 17 received placebo. A greater proportion of EDSS responders was observed in the RCI group at Day 7, 21, and 42 compared with the placebo group. Qualitative CGI-I showed that more patients receiving RCI were much improved or very much improved than with placebo. No meaningful differences were observed between treatment groups for MSIS-29. No serious AEs or deaths were reported.

The primary objective of the study was met, with more EDSS re-sponders in the RCI group vs the placebo group (61.1% [90% CI:4 2.0– 77.3] vs 11.8% [90% CI: 4.0–30.1], respectively) at Day 42

Conclusion: RCI is safe and effective for MS relapse patients who do not respond to high-dose corticosteroids.

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  • So a stronger form of corticosteroids? Would it have the potential to prevent long term damage from relapses or it will be similar to corticosteroids just faster recovery?

  • Dear MD possibly 3 by now:
    Heisenberg has been my guiding light since I was very young. Recently, I have found myself tracking your footprints, even if he was never yours.
    This is important to me and 3 generations of my descendants, as we rely primarily on familial oral history re neurodegenerative diseases when presenting ourselves to clinicians of any stripe, as we have learned through long and sometimes bitter experience that it’s just safest for us this way.
    Re steroids, D1 and I have learned to just say no, and we’ve both passed on this attitude. Re vaccination, we have all taken our own decisions. D1 and I both say no to flu vaccine because of previous bad reactions, but eligible due to MS D2 is a good girl. GD ineligible as she no longer lives in D1’s household, but GS chooses to protect his mum.
    However, things are a bit more fraught with SS-CV-2. I have said no to all vaccination with GP understanding and approval because of allegedly rare complications of EDS. D1 with EDS/SPMS is treble vaccinated as per government guidelines, and D2 with EDS/RRMS is double vaccinated. GD and GS with EDS remain unvaccinated because of age and/or vaccine availability.
    Despite regular breaching of household mixing regs due to practicalities on the ground, none of us has contracted any covid variant. I put this down to the fact that I have passed on my grandmother’s pre-1945 advice re TB/fever hospitals: outside every day, maintenance of adequate ventilation, and plenty of carbolic/more modern equivalent.
    Sadly, the state of the NHS since the start of the pandemic has caused all of us extensive collateral damage. These have included lack of GP access, chest infections following bog standard winter viruses being left without treatment, lack of access to hospital clinics on which we are normally reliant, and a traumatic childbirth during lockdown 1 (GD checked herself and her son out to D1 12 hours after emergency C-section).
    Remember Heisenberg…

  • PS: I’ve recently had a radiology registrar try to get away with the old academic canard ‘which Heisenberg’ in front of a particularly good and also experienced radiographer, who managed to confine her obvious glee to smirking .

  • These comments by Paula remind me of how my brain and writing might look to an outsider during relapse .. A collection of misorganized stream of consciousness.
    All the best Paula and feel better!

  • Paula, now I understand what you mean. I, myself, am actually a physicist (not a physician) so I fully understand your refs. But remember, quantum mechanics jargon is related to the subatomic space. once you scale up, things tend to be much more stable and the uncertainty reduce dramatically. Luckily, the science that we are talking about is few orders of magnitude larger (even CNS penetrating molecule is super large in scale, sorry MD). So subatomic particles follow quantum mechanics, but we (stuff that we can see under microscope) are pretty much restricted to the Newtonian space. I wouldn’t take much about our life and MS and associate directly with quantum space.

    • The old bastard never did get biological systems though. Same as biophysics has always left me cold. Perhaps sometimes it’s just best to lie back and think of Hogarth…
      Otherwise, anyone for the 3 body problem?

      Don’t teach yr granny to suck eggs!
      Never said I was a physicist, merely sired by one. Old bastard never did get biological systems.
      I’ve been a Brit resident for around 45 years, have done my lab time in both chem and biol sci, and am now more of a fading academic (not clinical).
      P 😂

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