FDA (US): Approved (1952, Acthar Gel) with several indications; since 2010 for infantile spasms in children under 2 years and for multiple sclerosis relapses in adults, in addition to other inflammatory indications. Also Purified Cortrophin Gel (reintroduced in 2021)
EMA (EU): Not approved through the centralized route. In Europe, tetracosactide (a synthetic ACTH fragment) in depot form is used instead, authorized through national routes
Infantile spasms: 150 U/m² a day intramuscularly divided into two doses for 2 weeks, followed by a gradual taper over another 2 weeks (FDA label Acthar Gel). Multiple sclerosis flares: 80–120 U a day for 2–3 weeks (FDA).
Like corticosteroids: greater risk of low potassium with diuretics, impaired glucose control with antidiabetic drugs, and reduced response to vaccines.
Small, randomized, blinded trial with 29 infants. With high-dose ACTH, 87% (13 of 15) responded vs 29% (4 of 14) with prednisone, defining response as cessation of spasms and normalization of the EEG.
View the study (RCT) →Brain and sleep, Hormones and metabolism, Immunity and defense
It activates the MC2R receptor of the adrenal cortex, which produces cortisol and other steroid hormones with an anti-inflammatory effect. It also acts on other melanocortin receptors in the brain and immune system, which could explain part of its effect in infantile spasms.
In people
Information, not medical advice. Prescription or unapproved peptides should only be used under medical supervision.