Acthar

Inflammation is different than infection.  Inflammation means that the body’s natural defenses have been triggered by something (surgery, trauma, or an infection) and a cascade has begun of cells and chemicals in order to fight it. Inflammation alone does not require antibiotics. Infection generally implies that there is some agent (bacteria, parasite or virus) that is causing a problem and usually triggers inflammation as well. Antibiotics might be appropriate here.

Inflammation of the eye can occur at any level: keratiis, scleritis,  retinitis and uveitis which can be anterior, posterior or in the middle (pars planitis). There are many diseases that can be associated with eye inflammation like multiple sclerosis, Crohn’s disease, irritable bowel and psoriasis.

Topical and oral steroids have been the mainstay of ocular inflammatory treatment for decades but keeping patients on them long-term is not ideal because of the many side effects that can occur like bone loss, gastric ulcers and fluid retention. Now, a drug that has long been approved for use in systemic inflammatory conditions like lupus, MR, sarcoid and rheumatoid arthritis is being used for severe allergy and other inflammatory eye conditions.

How does it work?  Acthar contains the hormone ACTH (adrenocorticotropic hormone) stimulating your own body to produce more natural steroid hormones so that patients can reduce or eliminate the need for additional steroids or other immunosuppressants like methotrexate or cyclosporine. Acthar has a non steroid anti-inflammatory effect since it uniquely binds to a specific receptor (melanocortin) to help down regulate both inflammation and the signals that keep inflammation going once started. These receptors are found on 5 different types of immune modulating cells throughout the body including T-helper and T-regulatory as well as macrophages and dendritic cells. Acthar is given as an in-home injection similar to insulin treatments once or twice week as needed.

Besides uveitis, Inflammation is at the root of many ocular diseases and conditions.   Acthar is currently being studied for many inflammatory diseases including optic neuritis. We now know that Dry Eye Disease, DED, is a T cell mediated inflammation and that medications that can disrupt the production of T cells can decrease DED signs and symptoms.   Acthar is not a first line of treatment for DED but it has helped in those difficult to treat dry eye patients who other treatments have not adequately controlled their signs and symptoms.  Many patients with DED have a systemic inflammation that is contributing to their eye problems and we have found that Acthar can help. 

Alright, let's simplify this:

Imagine your body is like a superhero, always ready to protect you from bad guys. Sometimes, your body gets a little confused and thinks there are bad guys when there aren't any. This makes your body start a big fight inside called "inflammation". It's like your body's way of trying to fix something, but it can sometimes cause trouble, especially in your eyes.

When your eyes get all inflamed, it can make it hard to see and even hurt them. Doctors used to give special medicines called steroids to calm down the fight inside your eyes. But these medicines can have some not-so-good side effects, like making your bones weak or giving you a sore tummy.

Now, there's a new medicine called Acthar. It's like a friend that helps your body make its own special superheroes that calm down the fight inside your eyes. Acthar doesn't have as many side effects as the old medicines because it helps your body in a different way.

So, when someone's eyes are having a big fight and need some help to calm down, doctors might give them Acthar to make them feel better. It's like calling in reinforcements to help your body win the battle and keep your eyes healthy.