Response to "Neurologists and the economics of MS treatment: Lighting candles, not cursing the darkness"
TundeOtulana, SVP, Chief Medical Officer, Mallinckrodt Pharmaceuticalstunde.otulana@mallinckrodt.com
Submitted April 27, 2017
In their editorial, Drs. Bourdette and Whitham mentioned "...avoiding use of repository corticotropin (Acthar gel) to treat MS relapses". [1] Objectively considering H.P. Acthar Gel, the only FDA-approved non-corticosteroid therapy option for multiple sclerosis (MS) relapse, as a treatment option is in the best interest of patients.
Steroids are the first-line treatment of MS relapse; however, NARCOMS data indicate that 30% of patients with MS relapse had no response to steroids. [2] Additionally, some patients cannot tolerate steroids. Nearly 20% of patients consider avoiding relapse therapy due to steroid adverse effects (AEs). [3]
The AE profile for steroids trended toward gastrointestinal and CNS side effects. [4] Acthar is different, trending toward hypertension and edema. When considering putative mechanism-of-action differences between the two treatment options, these AE findings are not surprising. [5]
Organizations like the AAN and the NMSS, have stated the need for alternative therapies for patients who cannot or will not take methylprednisolone for treatment of MS relapse.
It is important to consider the total cost related to the management and treatment of MS relapse which includes inpatient, outpatient, and pharmacy costs. By this measure, Acthar is a cost effective treatment option for MS relapse. [6]
H.P. Acthar Gel, with its qualitatively different side effect profile and different putative mechanism of action, provides an alternative treatment option for the appropriate patients.
1. Bourdette D, Whitham R. Neurologists and the economics of MS treatment: Lighting candles, not cursing the darkness. Neurology 2016;87:1532-1533.
2. Nickerson M, Cofield SS, Tyry T, et al. Impact of multiple sclerosis relapse: The NARCOMS participant perspective. Mult Scler Relat Disord 2015;4:234-240.
3. Jongen PJ, Stavrakaki I, Voet B, et al. Patient-reported adverse effects of high-dose intravenous methylprednisolone treatment: a prospective web-based multi-center study in multiple sclerosis patients with a relapse. J Neurol 2016;263:1641-1651.
4. Filippini G, Brusaferri F, Sibley WA, et al. Corticosteroids or ACTH for acute exacerbations in multiple sclerosis. Cochrane Database Syst Rev 2000:CD001331.
5. Arnason BG, Berkovich R, Catania A, Lisak RP, Zaidi M. Mechanisms of action of adrenocorticotropic hormone and other melanocortins relevant to the clinical management of patients with multiple sclerosis. Mult Scler 2013;19:130-136.
6. Gold LS, Suh K, Schepman PB, Damal K, Hansen RN. Healthcare Costs and Resource Utilization in Patients with Multiple Sclerosis Relapses Treated with H.P. Acthar Gel. Adv Ther 2016;33:1279-1292.
For disclosures, please contact the editorial office at journal@neurology.org.
In their editorial, Drs. Bourdette and Whitham mentioned "...avoiding use of repository corticotropin (Acthar gel) to treat MS relapses". [1] Objectively considering H.P. Acthar Gel, the only FDA-approved non-corticosteroid therapy option for multiple sclerosis (MS) relapse, as a treatment option is in the best interest of patients.
Steroids are the first-line treatment of MS relapse; however, NARCOMS data indicate that 30% of patients with MS relapse had no response to steroids. [2] Additionally, some patients cannot tolerate steroids. Nearly 20% of patients consider avoiding relapse therapy due to steroid adverse effects (AEs). [3]
The AE profile for steroids trended toward gastrointestinal and CNS side effects. [4] Acthar is different, trending toward hypertension and edema. When considering putative mechanism-of-action differences between the two treatment options, these AE findings are not surprising. [5]
Organizations like the AAN and the NMSS, have stated the need for alternative therapies for patients who cannot or will not take methylprednisolone for treatment of MS relapse.
It is important to consider the total cost related to the management and treatment of MS relapse which includes inpatient, outpatient, and pharmacy costs. By this measure, Acthar is a cost effective treatment option for MS relapse. [6]
H.P. Acthar Gel, with its qualitatively different side effect profile and different putative mechanism of action, provides an alternative treatment option for the appropriate patients.
1. Bourdette D, Whitham R. Neurologists and the economics of MS treatment: Lighting candles, not cursing the darkness. Neurology 2016;87:1532-1533.
2. Nickerson M, Cofield SS, Tyry T, et al. Impact of multiple sclerosis relapse: The NARCOMS participant perspective. Mult Scler Relat Disord 2015;4:234-240.
3. Jongen PJ, Stavrakaki I, Voet B, et al. Patient-reported adverse effects of high-dose intravenous methylprednisolone treatment: a prospective web-based multi-center study in multiple sclerosis patients with a relapse. J Neurol 2016;263:1641-1651.
4. Filippini G, Brusaferri F, Sibley WA, et al. Corticosteroids or ACTH for acute exacerbations in multiple sclerosis. Cochrane Database Syst Rev 2000:CD001331.
5. Arnason BG, Berkovich R, Catania A, Lisak RP, Zaidi M. Mechanisms of action of adrenocorticotropic hormone and other melanocortins relevant to the clinical management of patients with multiple sclerosis. Mult Scler 2013;19:130-136.
6. Gold LS, Suh K, Schepman PB, Damal K, Hansen RN. Healthcare Costs and Resource Utilization in Patients with Multiple Sclerosis Relapses Treated with H.P. Acthar Gel. Adv Ther 2016;33:1279-1292.
For disclosures, please contact the editorial office at journal@neurology.org.