PepRank

Corticotropin (repository ACTH gel)

43%positive15 reports

Also: Acthar Gel · Purified Cortrophin Gel · ACTH 1-39 · adrenocorticotropic hormone · repository corticotropin injection (RCI)

ExcludedImmuneInjection

Pituitary hormone gel approved for MS relapses; works like steroids, costs like a luxury car.

#58 of 61 research peptides · updated
Access
Approved drug
Cost / month
Almost $40,000 per 5 mL Acthar vial in 2021; January 2026 WAC about $9,300/mL (some $46,000 a vial) for Acthar and $7,200/mL for Cortrophin. One MS relapse course can exceed $100,000 before insurance.
Felt in 2–7 days

Builds over days or weeks of regular use rather than with each dose.

15 user reports
Glowing 1Positive 5Mixed 1Nothing 1Negative 3Bad reaction 4

  • r/MultipleSclerosis· · 2 upvotesOriginal ↗

    I remember starting to feel hints of normal for the first time in a long time. If memory serves, I had mild insomnia and a fantastic outlook on life - in retrospect, I was probably a hint hypomanic, but nothing unmanageable.

    GlowingImmune · Injection · 5 days

    MS relapse after intolerable and incomplete response to IV methylprednisolone

  • r/MultipleSclerosis· · 5 upvotesOriginal ↗

    Its not better for effectiveness it better on side effects for certain cases.

    PositiveImmune

    MS relapses, diabetic

  • r/sarcoidosis· · 5 upvotesOriginal ↗

    I also took this for about a year starting in 2020 but had to stop due to side effects.

    NegativeImmune · ~1 year

    sarcoidosis

Strict case
Drives the adrenals to flood the body with cortisol, so it carries the corticosteroid label warnings (infection, Cushing's syndrome, adrenal insufficiency on withdrawal, GI perforation, psychosis, high blood pressure and glucose, bone loss) plus anaphylaxis. A prescription relapse treatment under a neurologist, not something to take outside one.
Users report
Few first-hand reports, and most from rheumatology, lupus and sarcoid users rather than MS. MS users who could not tolerate IV methylprednisolone (diabetes, heart disease, reactions) describe it as gentler, with smaller blood-sugar spikes and less swelling, and some report striking relapse recovery ('I could walk again'). But it is still a steroid in effect: reports include mania or hypomania, hallucinations, insomnia, bloating and weight gain, a Cushing's syndrome diagnosis after months of use, very low heart rate, and heavy bruising. Insurance denials over the price are the most common complaint in the threads. Too few MS reports to judge how often it beats steroids for a given person. Felt nothing: One of 15 reports (Sjogren's) saw no improvement; another saw no relief alongside mania..
Best effects
Faster recovery from an MS relapse (versus placebo) · an option when IV or oral steroids fail or are not tolerated · possibly fewer steroid side effects for some (blood sugar, swelling)
Downsides
Insomnia, mood swings, euphoria or hypomania · fluid retention, bloating, weight gain, increased appetite · raised blood sugar · injection-site reactions · insurance denials and appeals over price
Watch
Corticosteroid-class harms carried on the label: serious infections, Cushing's syndrome, adrenal insufficiency after stopping, GI ulcers, bleeding and perforation, psychosis and severe depression, raised blood pressure and hypokalaemia, cataracts and glaucoma, bone loss · Hypersensitivity including anaphylaxis and angioedema; neutralising antibodies with chronic use (label, updated 2026) · May cause fetal harm (label)
Evidence
Approved drug — FDA-approved since 1952, indicated for acute MS exacerbations in adults; the evidence predates modern review. Placebo-controlled trials favour it for relapse recovery, but head-to-head trials find it no better than IV methylprednisolone. One small industry-funded RCT (n=35) in steroid non-responders. Oligodendrocyte protection is in vitro only.
Caveat
The FDA approval predates modern efficacy standards; independent reviewers find no evidence it beats far cheaper corticosteroids, and its price history (an FTC monopoly settlement of $100 million in 2017) shapes how it is prescribed and marketed. The steroid-sparing claim rests mostly on anecdote and manufacturer-funded studies.
Typical use
MS relapse (label): 80-120 units IM or subq daily for 2-3 weeks, sometimes tapered. Other indications: 40-80 units every 24-72 hours.
Getting it
Prescription only (US): Acthar Gel (Mallinckrodt, vials and SelfJect pen) and Purified Cortrophin Gel (ANI), both porcine-derived, via specialty pharmacy with manufacturer co-pay and free-drug programmes during insurance appeals. Synthetic depot tetracosactide (ACTH 1-24) is the analogue sold in some other countries. No grey-market supply.
Stacked with
Disease-modifying therapy (Ocrevus, Kesimpta, etc.): Used on top of a DMT to treat a relapse; it does not replace one. · IV methylprednisolone or plasma exchange: The usual alternatives; corticotropin is typically reserved for steroid failure or intolerance, with IVIG or plasma exchange as other second-line options.

User reports 15

  • r/MultipleSclerosis· · 2 upvotesOriginal ↗

    I remember starting to feel hints of normal for the first time in a long time. If memory serves, I had mild insomnia and a fantastic outlook on life - in retrospect, I was probably a hint hypomanic, but nothing unmanageable.

    GlowingImmune · Injection · 5 days

    MS relapse after intolerable and incomplete response to IV methylprednisolone

  • r/MultipleSclerosis· · 5 upvotesOriginal ↗

    Its not better for effectiveness it better on side effects for certain cases.

    PositiveImmune

    MS relapses, diabetic

  • r/MultipleSclerosis· · 2 upvotesOriginal ↗

    I'd pick it over solumedryl every time if I could, but I still use methylpred packs for minor sensory flares

    PositiveImmune · Injection

    optic neuritis flare; Solu-Medrol too hard on a heart condition

  • r/rheumatoid· · 2 upvotesOriginal ↗

    I was on it for about a year and a half! It worked well.

    PositiveImmune · ~18 months

    rheumatoid arthritis, later moved to Humira

  • r/MultipleSclerosis· · 1 upvotesOriginal ↗

    Okay I don't know the s word but I did the acthar gel. (Stopped using because steroids and diabetes suck) but omg wow I felt so much better! I could walk again!

    PositiveImmune · Injection

    MS relapse, diabetic

  • r/ChronicIllness· · 1 upvotesOriginal ↗

    it seems to be helping alot more than any steroids ever did.

    PositiveImmune

    uveitis, second course

  • r/rheumatoid· · 1 upvotesOriginal ↗

    It seemed like it was making a difference but I had to stop…was causing excessive bruising…looked like I had been beaten.

    MixedImmune

    Purified Cortrophin Gel for rheumatoid arthritis

  • r/Sjogrens· · 4 upvotesOriginal ↗

    I did a round of Acthar and has no improvement.

    NothingImmune

    Sjogren's

  • r/sarcoidosis· · 5 upvotesOriginal ↗

    I also took this for about a year starting in 2020 but had to stop due to side effects.

    NegativeImmune · ~1 year

    sarcoidosis

  • r/lupus· · 2 upvotesOriginal ↗

    Late update but acthar gel wasn’t successful for me it actually gave me more symptoms such as swollen red face and aggressive numbness.

    NegativeImmune

    lupus, Sjogren's and undifferentiated connective-tissue disease

  • r/lupus· · 1 upvotesOriginal ↗

    I get manic on steroids and this produced the same effect for me. I didn’t receive relief.

    NegativeImmune

    Purified Cortrophin Gel, autoimmune joint pain

  • r/MultipleSclerosis· · 1 upvotesOriginal ↗

    Acthar was truly the worst for me. My heart rate was very, very low. I was unable to bend my knees.

    Bad reactionImmune · two courses

  • r/ChronicIllness· · 1 upvotesOriginal ↗

    At first it was so great, and I felt back to my old self, but a day or two later I started having some strange side effects like hallucinating and sweating.

    Bad reactionImmune

    during a lupus work-up; tolerated high-dose steroids better

  • r/rheumatoid· · 1 upvotesOriginal ↗

    Update on Acthar - I developed Cushing syndrome and am being slowly taken off it. I gained 13 pounds on Acthar.

    Bad reactionImmune · Injection · ~9 months (every 3 days)

    rheumatoid arthritis

  • r/rheumatoid· · 1 upvotesOriginal ↗

    I took two injections of cortrophin gel and has a massive ovarian cyst rupture. It also messed with my menstrual cycle.

    Bad reactionImmune · two injections

    Purified Cortrophin Gel; causation unclear

Safety

Tier by safety barStrict ExcludedBalanced ExcludedEvidence only Excluded

Seen harmMechanismData gapSilent harmProduct

Seen harm 2/3
The Acthar label carries warnings for serious infections, Cushing's syndrome, adrenal insufficiency on withdrawal, GI perforation and bleeding, psychosis and severe depression, raised blood pressure and hypokalaemia, cataracts and glaucoma, bone loss, and anaphylaxis and angioedema (added 2026). These are mostly corticosteroid-class effects tied to prolonged courses; no deaths attributed to adult MS use were found, and Reddit adds a Cushing's diagnosis after months of rheumatology use. A stricter reading of 'several serious harms of different kinds' would make this a 3; the tier is the same either way. Acthar Gel prescribing information (FDA, revised 10/2026) ↗Reddit: Cushing's syndrome after months on Acthar (r/rheumatoid) ↗
Mechanism 2/3
Works by activating the hypothalamic-pituitary-adrenal axis: ACTH drives adrenal cortisol output, with immune suppression, glucose, blood-pressure and electrolyte effects, and suppresses the axis so that stopping can leave adrenal insufficiency. That is the hormone-axis category on the scale. Acthar Gel prescribing information, 5.1-5.3 and 12.1 Mechanism of Action ↗
Data gap 1/3
FDA-approved since 1952 with decades of use, but the approval predates modern standards and the MS evidence is small, old trials (the 1970 cooperative trial, a 61-patient comparison with methylprednisolone, a 35-patient RCT in 2022); a 2021 review counted 41 studies across all indications with 2,235 participants. Controlled MS data add up to well over a hundred people but there is no large modern trial, so it does not reach 0. Tran et al. 2021, JAMA Internal Medicine: evidence for repository corticotropin ↗Thompson et al. 1989, n=61 ↗Wynn et al. 2022 (OPTIONS), n=35 ↗
Silent harm 2/3
The hormone-axis harms build up and show on monitoring rather than being felt: blood glucose, blood pressure, potassium, adrenal suppression after stopping and, with long use, bone density and cataracts. Mood effects and insomnia are felt within days. Acthar Gel prescribing information, 5.2-5.3, 5.9 and 5.13 ↗
Product 0/3
Only available as manufactured, FDA-regulated porcine-derived gels (Acthar vials or SelfJect pen, Purified Cortrophin Gel) dispensed by specialty pharmacies and injected IM or subq; there is no grey-market supply. Purified Cortrophin Gel label (DailyMed) ↗
Never if
Intravenous administration (label) · Scleroderma, osteoporosis, systemic fungal infection, ocular herpes simplex or recent surgery (label) · Current or past peptic ulcer, congestive heart failure or uncontrolled hypertension (label) · Primary adrenocortical insufficiency or adrenocortical hyperfunction (label) · Hypersensitivity to corticotropin, its excipients or porcine proteins (label) · Live or live-attenuated vaccines while on immunosuppressive doses (label) · Pregnancy, unless a doctor judges the benefit worth possible fetal harm (label)

Studies 5

Sources 5

More in Neuroprotection & repair all 10 →

  1. 1ARA-290 QEQLERALNSS (11 residues) Caution Injection≈ €180–630 / month56%positive40 reportsNon-erythropoietic EPO-derived peptide for small-fibre neuropathy pain.
  2. 2Cortexin Caution Injection≈ €36–90 / month50%positive20 reportsRussian brain-cortex extract, Cerebrolysin cousin; 10-day IM courses.Animal-brain extract given by injection: immune/allergic and theoretical prion risk, and it shares Cerebrolysin's SAE signal.
  3. 3P21 (P021) DGGL (4 residues) Caution Nasal / Oral / Injection≈ €45–180 / month43%positive15 reportsCNTF-derived neurogenic peptide from Alzheimer's mouse work; grey market only.No human safety data; deliberately drives neurogenesis via a growth-factor pathway, and products are of uncertain identity.
  4. 4NAP / Davunetide NAPVSIPQ (8 residues) Clean Nasal2/10estimateADNP-derived microtubule-stabilising peptide; safe in a large trial but ineffective.
  5. 5Dihexa YI (2 residues) Excluded Oral / Topical / Injection≈ €13–53 / month50%positive30 reportsAngiotensin-IV analogue claimed as potent synaptogenic; hyped, not evidenced in humans.Activates the oncogenic HGF/c-Met pathway, has no human safety data, and its foundational studies are under expressions of concern.
  6. 6Humanin MAPRGFSCLLLLTSEIDLPVKRRA (24 residues) Excluded Injection43%positive1 reportsMitochondrial-derived cytoprotective peptide; anti-Alzheimer's in animals only.Its anti-apoptotic action helps glioma cells survive chemotherapy in animal studies, and there is no human data.
  7. 7FGL EVYVVAENQQGKSKA (15 residues) Excluded Nasal / Injection43%positive1 reportsNCAM mimetic that activates FGF receptors; rodent memory data only.Agonist of the mitogenic FGF receptor, with only phase-1 data and no users to learn from.
  8. 8Cerebrolysin Excluded Nasal / Injection / IV≈ €140–540 / month40%positive29 reportsPig-brain peptide mix for stroke/TBI; strong anecdotes, real safety questions.Cochrane found more non-fatal serious adverse events than placebo; animal-derived injectable with allergy/immune reaction risk.
  9. 9Glatiramer acetate Excluded Injection37%positive24 reportsApproved MS drug made of random myelin-mimicking peptide chains; modest relapse cut, injection burden.Prescription immunomodulator for relapsing MS with an FDA boxed warning for anaphylaxis (82 cases, 6 deaths reported to 2024, some years into treatment), plus label warnings for liver injury and skin necrosis. Worth it for MS under a neurologist; not a self-directed peptide.

Sequence beads

Each bead is one amino acid in the peptide's chain, coloured by its side chain: grey for non-polar, cyan for polar, blue for positively charged and fuchsia for negatively charged. Length and mix tell related peptides apart at a glance, from a two-residue dipeptide like carnosine to a 43-residue protein like thymosin beta-4. The colours describe chemistry only and predict neither effect nor safety.

non-polarpolarpositivenegative

Report grades

Every first-hand Reddit or X report is graded on its own, from glowing through positive, mixed, nothing and negative to bad reaction, and the bar shows how those grades split. Posts that look vendor-adjacent stay on the peptide's page but are left out of the counts.

GlowingPositiveMixedNothingNegativeBad reaction

% positive

The share of a peptide's graded Reddit and X reports that are glowing or positive, vendor-adjacent posts left out. A peptide with few reports is pulled toward the average of all reports, as if it had eight average ones besides its own, so two glowing posts cannot top the list. Kept peptides rank by the same reports' mean grade, shrunk the same way, and excluded ones follow in that order.

Researcher estimate

No first-hand report of this peptide has been graded yet, so the figure is the researchers' own rating out of 10 from what they read about it. It ranks alongside the computed scores until reports arrive.

Safety tier

Each peptide is tiered clean, caution or excluded from its five risk axes under the chosen safety bar. An excluded peptide has a plausible route to serious harm, so it stays listed with the reason but ranks behind every other entry, however good its reviews.

Safety bar

The safety bar sets how much risk it takes to exclude a peptide. Strict: out on any serious mechanism with little human data, or any documented serious harm. Balanced: out on documented serious harm (unless it is obvious, reversible and from a regulated product), or a serious mechanism whose harm would be silent with no human data at all. Evidence only: out only on documented serious harm in humans that is lasting, delayed or from grey-market product.

Seen harm

Documented serious adverse events in humans, from 0 for none despite real exposure to 3 for deaths or several well-documented serious harms. Serious means a hospital or emergency visit or harm lasting weeks, so a headache or a bad night does not count.

Mechanism

A plausible biological route to serious harm at the doses people use, such as growth-factor signalling, hormone-axis suppression, heart or blood-pressure effects or immune activation. It runs from 0 when none is known to 3 when a dangerous pathway has been shown in living animals.

Data gap

How little human safety data exists for the molecule actually sold, from 0 for an approved drug with large trials and years of use to 3 for no human safety data at all. A modified analogue does not inherit its parent's trials.

Silent harm

Whether the feared harm would show quickly or stay hidden, from 0 when it is obvious and goes on stopping to 3 when it is silent and delayed, like tumour promotion or slow organ damage. User reports cannot reveal a harm that takes years to appear, so a high score here limits what good reviews can tell you.

Product

The risk of what people actually buy, from 0 for a regulated pharmacy or supplement product taken by mouth or on the skin to 3 for a grey-market injectable. In one dataset of 6,441 grey-market samples, 42–71% failed basic quality criteria and 15% carried endotoxin.

Evidence

The strongest kind of study behind the peptide's effects, from an approved drug through human controlled trials and small human studies to animal work or nothing of its own. Animal results often fail to carry over to people.

Access

How people get it: as an approved drug, a compounded prescription, an over-the-counter supplement or from the grey market, where nobody checks the vial. The channel decides both the legal position and the risk of a bad batch.

Price per month

Thirty days of the typical dose, from its low end to its high end, priced at the listing a careful buyer would choose: in stock, from a shop scoring 4 of 5 on trust (third-party tested where no score is set), failing that 3, a pure pack before a blend, a European shop first, then the cheapest per mg. The range is the dose's, not the shops'. A per-dose amount counts once a day unless the dose says otherwise. Prices are in euros at ECB rates of 2026-10-29, before shipping; the shop table keeps each listing's price per mg, per gram for bulk supplements. Where no listing can be priced the researchers' own estimate stands in, and says so.

Dose users report

The middle half of the daily doses stated in at least five first-hand reports, vendor posts left out. Where its middle sits more than twice above or below the declared dose, the month is priced at it as well, since what people take is what they pay for.

Testing

Whether the shop publishes lab results: third-party tested means an independent lab checks each batch, own COA means the shop's own certificate of analysis, and no public tests means neither. A certificate shows purity, not safety.

Added peptide

Some packs sold under one peptide's name hold a second one, such as 5 mg GHK-Cu in a nasal kit, stated only in the description. Sprayed in the nose or injected it reaches the blood like an injection, so it carries the risk of that route and is tiered as the injectable form, whatever its tier on the skin. A pack whose page gives no contents list may hold more than its name.