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Diffuse Lung Disease |

Acthar Gel for Chronic Pulmonary Sarcoidosis: Role of Positive Emission Tomography in Initial Assessment and in Response to Therapy FREE TO VIEW

Robert Baughman, MD; Mariano Fernandez-Ulloa; Ralph Shipley; Felicia Thompson; Elyse Lower
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University of Cincinnati, Cincinnati, OH


Chest. 2015;148(4_MeetingAbstracts):392A. doi:10.1378/chest.2273825
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Abstract

SESSION TITLE: Diffuse Lung Disease Poster Discussions

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Wednesday, October 28, 2015 at 02:45 PM - 04:00 PM

PURPOSE: Scanning with (18)F-fluorodeoxyglucose positron emission tomography (PET/CT) has been increasingly used to identify inflammation in patients with active sarcoidosis. PET/CT scanning has also been reported effective in identifying patients more likely to respond to therapy. Adrenocorticotrophic hormone (Acthar gel) was the first drug approved in the United States for sarcoidosis. This study evaluates PET scanning versus other measures of functional activity prior to and after Acthar gel institution in previously treated pulmonary sarcoidosis patients.

METHODS: Patients with progressive pulmonary disease during the previous year with a documented ≥ 5% decrease in forced vital capacity (FVC) despite ≥ 5 mg of prednisone daily were eligible for study. Prior to study drug administration, patients underwent spirometry, six minute walk test (6MWT), and PET/CT scanning. Patients were randomized to receive either 40 or 80 units (U) of Acthar gel daily for ten days then twice a week for a total of 24 weeks. The prednisone dose was tapered as tolerated by the patient with both initial and final daily doses of prednisone noted. Spirometry, 6MWD testing, and PET/CT scanning were repeated at 24 weeks.

RESULTS: To date, five patients have completed the entire 24 weeks of study. At drug institution, increased (18)F-fluorodeoxyglucose uptake was noted in one or more areas consistent with active sarcoidosis in all patients. However, after 24 weeks of treatment, PET/CT update had decreased in all cases. In three cases, a standardized uptake value (SUV) could be assigned to one or more lesions and the follow-up SUV fell significantly in all all three cases. Four patients were able to perform 6MWT at both time points (the other patient had severe back pain and declined the testing). In all four cases, there was an increase in 6MWT distance (130 [8-260] meters [Median{Range}]). There was no significant difference in the FVC between initial (2.80 [1.21-3.55] L) and 24 week (2.82 [1.15-3.65] L) testing. All patients were receiving ≤ 10 mg a day of prednisone by 24 weeks.

CONCLUSIONS: Patients with chronic pulmonary sarcoidosis with progressive disease despite aggressive immunosuppression may still have active sarcoidosis demonstrated by PET/CT scanning.

CLINICAL IMPLICATIONS: PET/CT scanning may be useful in identifying whihc sarcoidosis patients with advanced disease may still respond to alternative anti-inflammatory treatments.

DISCLOSURE: Robert Baughman: Grant monies (from industry related sources): Mallinckrodt, Consultant fee, speaker bureau, advisory committee, etc.: Mallinckrodt Felicia Thompson: Grant monies (from industry related sources): Mallinckrodt Elyse Lower: Grant monies (from industry related sources): Mallinckrodt The following authors have nothing to disclose: Mariano Fernandez-Ulloa, Ralph Shipley

Acthar gel is approved for pulmonary sarcoidosis. CT/PET scan is not approved for sarcoidosis.


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