#ECTRIMS2019 – Acthar Gel Seen as Cost-effective Late-line Treatment Option for MS Relapses

Late-line use of H.P. Acthar Gel to treat relapses in adults with multiple sclerosis (MS) is linked with lower costs than other therapies used after an initial poor response, including plasmapheresis and intravenous immunoglobulin, according to an analysis by Mallinckrodt Pharmaceuticals, the treatment’s marketer.

George Wan, PhD, Mallinckrodt’s vice president and global head of health economics and outcomes research, presented the data in the poster “Cost Per Response Analysis of Repository Corticotropin Injection versus Other Late-Line Treatments for Multiple Sclerosis Relapses in Adults,” at the 35^th congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) that concluded Sept. 13 in Stockholm.

Relapses in MS not only may lead to progression of disability, but are also linked with a high cost burden. Corticosteroids are the first choice for managing relapses, but not all patients are able to use this treatment, and some who do fail to respond to it.

In these cases, late-line treatment options include H.P. Acthar Gel (repository corticotropin injection), plasmapheresis (a process used to ‘clean’ the blood by removing the plasma — the liquid portion of blood — and then returning the blood to the patient’s body), or intravenous immunoglobulin (antibody-based therapy).

“Suboptimal management of MS relapses may lead to residual deficits, poor recovery, and progressive disability. In addition, not all patients tolerate or respond effectively to first-line agents such as corticosteroids. As a result, healthcare providers may turn to late-line therapies,” Wan said in a press release.

Researchers compared the cost per response of these late-line treatments in resolving MS relapses. Response was defined as needing no additional relapse treatment within 30 days of using the therapy targeted for this study. Costs included the need for inpatient and outpatient care, and medication charges.

“This analysis is aimed at addressing the current lack of evidence comparing the cost per response of late-line treatments for MS relapse,” Wan said.

The team analyzed the cost per response of each therapy — meaning the annual cost of care per patient achieving MS relapse resolution — among people with one or more relapses per year. The cost estimation was done using five-year data (July 2007 to December 2012) from the Truven Health Analytics MarketScan Commercial Claims and Encounters Databases, and inflated to 2019 U.S. dollars.

Analysis found that the annual cost with late-line treatment was, on average, similar among all patients, but the cost per response with Acthar Gel was lower ($141,970) than that of the other therapies ($253,331).

The response rate among patients treated with Acthar Gel was also higher (86.6%) than among patients given plasmapheresis or intravenous immunoglobulin (49.9%).

Overall, “these findings shed light on the importance of late-line treatment selection strategies for patients with acute exacerbations of MS,” the researchers wrote.

They also noted the importance of selecting an appropriate late-treatment in resolving MS relapses in a timely manner, in order to minimize patient burden.

H.P. Acthar Gel was approved by the U.S. Food and Drug Administration (FDA) in 1978 to treat 19 indications, including as a treatment for acute MS flares in adults with frequent and recurring relapses. According to the National Multiple Sclerosis Society, it is a highly purified preparation of adrenocorticotropic hormone (ACTH), which stimulates the adrenal cortex gland to secrete cortisol, corticosterone, and aldosterone.

Of note, two of the study’s three researchers are Mallinckrodt employees; the other was a paid consultant for the company.