# Corticotropin (repository ACTH gel)

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

- Page: https://peprank.xyz/peptides/corticotropin
- Category: Neuroprotection & repair (Research peptide)
- Also known as: Acthar Gel; Purified Cortrophin Gel; ACTH 1-39; adrenocorticotropic hormone; repository corticotropin injection (RCI)
- Routes: Injection
- Safety tier: Strict: Avoid · Balanced: Avoid · Evidence only: Avoid
- Risk axes (0 none to 3 severe): Seen harm 2, Mechanism 2, Data gap 1, Silent harm 2, Product 0
- Positive: 43% of 15 graded reports glowing or positive, shrunk toward the 49% all-report average by 8 reports' weight
- Rank: #49 of 61 research peptides
- Graded reports: 15 (Glowing 1, Positive 5, Mixed 1, Nothing 1, Negative 3, Bad reaction 4)
- 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.
- Access: Approved drug
- Onset: Relapse symptoms usually start easing within days to a week of daily injections.
- Lasts: A relapse course is 2-3 weeks; rheumatology users inject every 1-3 days for months.
- Cost per 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.
- Updated: 2026-10-30

**Why Avoid under the strict bar:** 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.

## What 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..

**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

**Risks:** 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)

**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.)

## Risk profile

- **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.
- **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.
- **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.
- **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.
- **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.
- **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)

## Top reports

- Glowing, immune: “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.” — [r/MultipleSclerosis](https://www.reddit.com/r/MultipleSclerosis/comments/1eihxzu/acthar_gel/lgeh45d/)
- Positive, immune: “Its not better for effectiveness it better on side effects for certain cases.” — [r/MultipleSclerosis](https://www.reddit.com/r/MultipleSclerosis/comments/rhtw61/there_is_minimal_evidence_that_the_expensive/hot2zyo/)
- Positive, immune: “I'd pick it over solumedryl every time if I could, but I still use methylpred packs for minor sensory flares” — [r/MultipleSclerosis](https://www.reddit.com/r/MultipleSclerosis/comments/132e132/acthar_gel/jzvcjbg/)
- Positive, immune: “I was on it for about a year and a half! It worked well.” — [r/rheumatoid](https://www.reddit.com/r/rheumatoid/comments/eon8ev/acthar_gel_does_anyone_take_this/feea03y/)
- Positive, immune: “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!” — [r/MultipleSclerosis](https://www.reddit.com/r/MultipleSclerosis/comments/132e132/acthar_gel/ji512ar/)

## Studies

- [Rose et al. 1970: cooperative study, ACTH vs placebo in acute MS exacerbations (final report)](https://pubmed.ncbi.nlm.nih.gov/4314823/) (rct, 1970): The multicentre placebo-controlled trial behind the MS indication; the label states controlled trials showed faster resolution of exacerbations but no effect on the ultimate course of the disease.
- [Thompson et al. 1989: IV methylprednisolone vs ACTH for acute relapse in MS](https://pubmed.ncbi.nlm.nih.gov/2544829/) (rct, n=61, 1989): Double-blind; both groups improved markedly with no difference in rate of recovery or final outcome.
- [Wynn et al. 2022 (OPTIONS): repository corticotropin for MS relapse not responding to corticosteroids](https://pubmed.ncbi.nlm.nih.gov/34984839/) (rct, n=35, 2022): 80 U daily for 14 days gave more EDSS responders than placebo at days 7, 21 and 42, but no difference on the MSIS-29 patient-reported scale; no serious adverse events; funded and co-authored by the manufacturer.
- [Tran et al. 2021: clinical evidence supporting repository corticotropin for FDA-approved indications (JAMA Internal Medicine)](https://doi.org/10.1001/jamainternmed.2021.7171) (review, n=2235, 2021): 41 studies; MS had the most controlled evidence, with corticotropin almost always better than placebo but no different from corticosteroids; the authors say continued use should be discouraged without head-to-head trials.
- [Benjamins et al. 2014: ACTH 1-39 promotes proliferation and differentiation of oligodendroglial progenitors](https://doi.org/10.1002/jnr.23416) (in-vitro, 2014): In rat glial cultures, ACTH increased oligodendrocyte precursor numbers, sped their maturation and protected them from excitotoxic and oxidative injury, a steroid-independent 'repair' signal not tested in people.

## Sources

- [Acthar Gel prescribing information (FDA label, revised October 2026)](https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/008372s088lbl.pdf)
- [Purified Cortrophin Gel label (DailyMed)](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=f27544ee-a0e2-4d84-b193-1c9efdf9e34c)
- [OHSU 2021: 'Massive cost, meager benefit' (on the JAMA Internal Medicine review)](https://news.ohsu.edu/2021/12/13/massive-cost-meager-benefit)
- [FTC 2017: Mallinckrodt pays $100 million over its Acthar monopoly](https://www.ftc.gov/news-events/news/press-releases/2017/01/mallinckrodt-will-pay-100-million-settle-ftc-state-charges-it-illegally-maintained-its-monopoly)
- [QuickRx 2026: Cortrophin Gel vs Acthar Gel cost (WAC per mL)](https://quickrxspecialty.pharmacy/cortrophin-gel-vs-acthar-gel-cost-comparison/)