A Retrospective Study of Utilization of Repository Corticotropin Injection (HP Acthar Gel) as Pretreatment for Alemtuzumab Infusion

Background: Alemtuzumab treatment of patients with MS is associated with cytokine release, resulting in infusion-associated reactions (IARs). Premedication with corticosteroids is typically administered to alleviate the risk of IARs, but steroid pretreatment is not feasible in some patients. This study investigated real-world experience using repository corticotropin injection (RCI) as a pretreatment for alemtuzumab infusion. Methods: A retrospective study of patients who were prescribed RCI as pretreatment for the prevention of alemtuzumab IARs was conducted using an electronic questionnaire. Data were de-identified at the time of collection. Results: Complete information on 175 patients was collected and analyzed. Data for alemtuzumab Course 1 infusions were available for 175 patients; 23 of these also had data available for Course 2 infusions. Patients were 62% Caucasian, 21% black, 15% Hispanic, and were diagnosed with relapsing forms of MS (60%) or progressive forms of MS (40%). Reasons for using RCI prior to alemtuzumab included history of steroid intolerance (Course 1: 37%, Course 2: 59%), history of poor response to steroids (20%, 27%), and comorbidities (20%, 27%). RCI was most frequently administered subcutaneously at a dose of 80 units. No IARs occurred in 56% (Course 1) and 61% (Course 2) of patients after RCI pretreatment. No adverse events attributed to RCI were seen in 72% and 91% of patients treated with Course 1 and 2, respectively. Conclusion: RCI is a safe, effective, and well-tolerated pretreatment alternative to corticosteroids to alleviate the risk of alemtuzumab-associated infusion reaction in patients with MS.