DR. KHASTGIR. l\l.D.

OKLA  

Office
Fax

112

 
 

Dear Mri Drash,

Thank you for reaching out to me regarding your questions and concerns
on Acthar. Acthar is a FDA approved and indicated drug for the treatment
of Idiopathic Nephrotic and Lupus class 4i

When it became available in 2012 to the nephrology community we were
sceptical olits use and mechanism of action. More research into the
matter revealed that Catalina at all reported in 1003--2006 that there are
live \lelanocortin Receptors that are present in the body to which 
binds to. ACTH is the parent compound ot'Acthar, ACTH binding to the
receptors maybe the mechanism for improved proteinuria. ACTH
binding to receptors on the Adrenal Glands causes the side effects,
Further studies regarding the mechanism of actions are currently on
going.

Patients who had been treated with the other drugs such as (Steroids.
'l'aerolimus, Mall", Rituximab etc) were given a trail of this drug and some
of them responded, Response meant a decrease in protein spillage, a
slowing down. or even arresting kidney decline, a stalling or even
preventing the need for dialysis and or transplant down the road.
Although expensive, it is worth trying on a selective group of patients
either re 'stant or non~responders or otherwise not a candidate to other
therapy. Anything to keep these patients from going down the ominous
road to Dialy 

have lost patients to side effects to other drug regimens for Nephrotic
like the Ponticilli Regimen. This (11' ppears to be relatively
safe. I have collaborated with five other physicians across the country

 

using ?MedVal? to do a retrospective study and Mallincrodt funded that
study. I am a speaker for the company and will talk to ephrologists on
lunch or dinner programs presenting the data on the drug. My expenses
are paid for by the company. The contract with Mallinerodt is in line with
other consultant/speaker agreements done in the past.

May I ask, what you would do if you had ephrotic resistant to
other drug therapy and your only hope was an expensive drug or an
expensive organ replacement/dialysis. And what would you do if your 18
year old daughter gets diagnosed with a rare form of Nephrotie 
and the choice is to use drugs that will cause Infertility for life and
possible Blood Cancers down the road or use an expensive drug with
minimum side effects?

Thanks again for reaching out to me regarding questions on this drug. Hi
can be of any further assistance please do not hesitate to contact me.

Best Wishes,

Anup Khastgir . .