Background: Treatment of multiple sclerosis (MS) relapses can be complex in patients with concomitant diabetes. Corticosteroids and adrenocorticotropic hormones are known to cause alterations in glucose tolerance. Many patients have poor tolerability to therapy, necessitating alternative treatment options. Adrenocorticotropic hormone (H.P. Acthar Gel, repository corticotropin injection, Mallinckrodt ARD Inc., Hazelwood, MO, USA) is currently indicated for the treatment of MS relapses.
Objectives: The objective of this study was to review patients' experiences of Acthar Gel for the treatment of MS exacerbations in patients with MS and diabetes.
Methods: A retrospective review of 13 patients' experiences with treatment. Qualified healthcare providers completed a questionnaire following Acthar Gel treatment for MS relapse.
Results: Previous corticosteroid treatment with either intravenous methylprednisolone or prednisone was reported by 84.6% of patients; eight patients had complications following administration of prior steroid treatment, seven of whom experienced elevated blood glucose levels. Acthar Gel was administered daily for a mean of 5.3 days, with 61.5% of patients reporting relapse resolution. Two patients experienced elevated blood glucose.
Conclusion: The majority of patients experienced a timely resolution of their MS relapse with few hyperglycemic adverse events. Although more studies are necessary, these data suggest that Acthar Gel may be a well-tolerated and effective treatment option for patients with diabetes experiencing an MS relapse.
Keywords: Acthar Gel; blood glucose; diabetes mellitus; hyperglycemia; multiple sclerosis; steroids.