OBJECTIVES: Nephrotic syndrome (NS) is a glomerular disorder with an incidence of 3-5 new cases per 100,000 people in the United States. First-line treatment consists of corticosteroids (CS) and/or calcineurin inhibitors (CNIs), but complications or non-response to first-line treatment warrant additional treatment options. Acthar® Gel is indicated for the treatment of proteinuria in nephrotic syndrome. This study characterized patients treated with Acthar and the impact of adherence on outcomes.

METHODS: A retrospective cohort analysis of NS patients from a large commercial claims database (Symphony Health, 2016-2022) to evaluate the benefits of treatment adherence on outcomes. Acthar adherence cohorts were determined by mean proportion of days covered (PDC) with patients categorized as above average (AA) and below average (BA) PDC. Patient outcomes were compared by adherence cohorts.

RESULTS: Patients in the Acthar AA cohort (n=120) were similar in age, ethnicity, and gender to the BA cohort (n=146), with a lower comorbidity index score (2.1 vs 2.5). Duration of Acthar treatment was significantly longer for AA patients (275 vs 105 days, p<0.001) with more fills (11 vs 4, p<0.001) in the follow-up vs BA. The AA and BA cohorts both had significant reductions in proportion of patients on corticosteroids overall and extended use CS (≥60 days) (p<0.05). AA patients had lower proportion on NSAIDs (28% vs 45%, p=0.03), dialysis (6% vs 19%, p=0.001) and receiving renal transplant (8% vs 13%) compared to BA in the follow-up. The AA cohort had significantly fewer inpatient hospitalizations, ED visits, and medical costs vs BA cohort. Similar results were seen within the NS subtypes to the full adherence cohorts.

CONCLUSIONS: Acthar Gel is a viable treatment option for patients that don’t respond to CS and/or CNIs, with higher adherence associated with greater steroid-sparing effect, less need for renal transplant and reduced healthcare resource use.