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QCORs Acthar & MS Pathology Explanation

|Includes: Mallinckrodt PLC (MNK)

There have been a lot of headlines the last 2 days, and in this Author's opinion, some misinterpretations/misunderstandings of what Acthar actually is.

I already wrote an article on the UNH Bulletin and my interpreted impact, so I won't be redundant and go into too much detail on that here.

However, with all the lawsuits being filed, and headlines that have negative words like 'limiting' and 'restricting', it would be helpful to understand this drug.

I have a BSN, but I'm going to attempt to keep this in layman's terms.

With that in mind, let's discuss a few topics.

What is ACTH?

Adrenocorticotropic hormone (ACTH) is produced and secreted by your Anterior Pituitary gland. Note that it is a hormone, not a drug. Your Pituitary gland is basically under and in between the 2 lobes of your brain.

Your body produces it in response to a stressor acting on you. The hormone is released into your blood stream and when it gets to your adrenal cortex (little glands right up next to your kidneys) it tells your body to release cortisol which does two things. First, it speeds up the release of nutrients into your body, to combat the stress (glucose, proteins, etc.). The second thing it does, is tells your body to decrease the immune response.

Here is a nice Picture of those 2 paragraphs.

Remember, this is a hormone that your body makes all the time, to maintain a balance of cell metabolism and immune responses. In fact, it only lasts 5 to 10 minutes in your blood, so you really are constantly producing it.

What is Acthar?

Let's keep it simple here, since you could go to QCOR's website to find a lot of information in this powerpoint.

Acthar is a drug that contains three hormones, some other peptides for signaling and joining, etc. One of those hormones is ACTH.

What is MS?

Multiple Sclerosis is an inflammatory disease in which the myelin sheaths around the axons are attacked and destroyed by your immune system.

That's an accurate one sentence summary of the disease, but what does that mean?

Think of the axons as copper wires running inside the walls of your house, and the myelin sheaths as the insulation around the wires. If the insulation is damaged, then you could have a real problem on your hands. Short circuits, fires, loss of power, etc. Your nerve cells work the same way.

Doesn't sound like much fun really, having a bunch of exposed wires in your head. Remember it is your immune system that is causing the damage.

How does Acthar help?

We know now what the hormone ACTH is, and what it does. We also have a good grasp on what MS is and what causes it.

Acthar contains ACTH and provides your body extra immuno-suppression when your body is attacking itself. When an MS patient has an exacerbation episode, and the immune system is actively damaging the insulation around nerve cells, ACTH acts to stop it.

Simply put, if a mouse is chewing on the wires in your house, Acthar takes care of that mouse and stops others from coming in.

Why did UNH put limitations/restrictions on Acthar's use?

I don't see that they did, in fact, their policy now follows the prescribing information that (QCOR) provides to them, and that the FDA approved.

Authors, of some of these headlines, read the change from 3 months to 3 weeks, and assumed it was negative.

Something to keep in mind is that an over abundance of ACTH in your system, causes Cushing's Syndrome. Again, your body produces ACTH all the time. So, adding more ACTH into your system, to suppress your immune system, could result in the same effect as someone born with Cushing's Syndrome, due to an endrocine system problem.

Also, an exacerbation, by definition, is a short lived flare up. Acthar is not a cure, it's purpose is to treat those flare up symptoms and hopefully stop further damage.

Disclosure: I am long QCOR.