| Infantile Spasm
Acthar vs Sabril
Side-by-side clinical, coverage, and cost comparison for infantile spasm.Deep comparison between: Acthar vs Sabril with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsSabril has a higher rate of injection site reactions vs Acthar based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Sabril but not Acthar, including UnitedHealthcare
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Category
Acthar
Sabril
At A Glance
IM or SC injection
Corticotropin analog
Oral
Twice daily
GABA-T inhibitor
Indications
- Infantile Spasm
- Multiple Sclerosis
- Arthritis, Psoriatic
- Rheumatoid Arthritis
- Ankylosing spondylitis
- Lupus Erythematosus, Systemic
- Dermatomyositis
- Polymyositis
- Erythema Multiforme
- Stevens-Johnson Syndrome
- Serum Sickness
- Keratitis
- Iritis
- Iridocyclitis
- Uveitis, Posterior
- Choroiditis
- Optic Neuritis
- Chorioretinitis
- Sarcoidosis
- Nephrotic Syndrome
- Complex partial seizures
- Infantile Spasm
Dosing
Infantile Spasm 150 U/m2/day IM divided into 75 U/m2 twice daily for 2 weeks, then taper over 2 weeks; Acthar Gel vial only -- do not use the pre-filled SelfJect injector.
Multiple Sclerosis 80-120 units IM or SC daily for 2-3 weeks for acute exacerbations; taper as needed.
Arthritis, Psoriatic, Rheumatoid Arthritis, Ankylosing spondylitis, Lupus Erythematosus, Systemic, Dermatomyositis, Polymyositis, Erythema Multiforme, Stevens-Johnson Syndrome, Serum Sickness, Keratitis, Iritis, Iridocyclitis, Uveitis, Posterior, Choroiditis, Optic Neuritis, Chorioretinitis, Sarcoidosis, Nephrotic Syndrome 40-80 units IM or SC every 24-72 hours; individualize dosing based on disease severity and patient response; taper dose upon discontinuation.
Complex partial seizures Adults: initiate at 1000 mg/day (500 mg twice daily) orally; recommended dose 3000 mg/day (1500 mg twice daily). Pediatric patients 2-16 years: weight-based dosing in two divided doses, starting 350-500 mg/day and maintenance 1050-2000 mg/day; patients >60 kg follow adult dosing.
Infantile Spasm Initiate at 50 mg/kg/day orally in two divided doses (25 mg/kg twice daily); titrate by 25-50 mg/kg/day every 3 days up to a maximum of 150 mg/kg/day (75 mg/kg twice daily).
Contraindications
- Intravenous administration
- Use in infants under 2 years of age with suspected congenital infections
- Concomitant live or live-attenuated vaccines during immunosuppressive doses of Acthar Gel
- Scleroderma
- Osteoporosis
- Systemic fungal infections
- Ocular herpes simplex
- Recent surgery
- History of or presence of peptic ulcer
- Congestive heart failure
- Uncontrolled hypertension
- Primary adrenocortical insufficiency
- Adrenocortical hyperfunction
- Sensitivity to proteins of porcine origin
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Adverse Reactions
Most common (>=5%) Infections, convulsions, hypertension, irritability, pyrexia (reported in infantile spasm trials at recommended dose)
Serious Cushing's syndrome, adrenal insufficiency upon withdrawal, elevated blood pressure, salt and water retention, hypokalemia, gastrointestinal perforation and bleeding, behavioral and mood disturbances, ophthalmic effects, decreased bone density, negative effects on growth and physical development
Postmarketing Anaphylaxis, necrotizing angitis, pancreatitis, intracranial hemorrhage, subdural hematoma, reversible brain shrinkage, vertebral compression fractures, insomnia, injection site reactions
Most common (>=5%) Headache, somnolence, fatigue, dizziness, convulsion, nasopharyngitis, weight gain, upper respiratory tract infection, visual field defect, depression, tremor, nystagmus, nausea, diarrhea, memory impairment, insomnia, irritability, abnormal coordination, blurred vision, diplopia, vomiting, influenza, pyrexia, rash
Serious Permanent vision loss, MRI abnormalities in infants, neurotoxicity, suicidal behavior and ideation, anemia, peripheral neuropathy, somnolence and fatigue, weight gain, edema
Postmarketing Congenital cardiac defects, deafness, developmental delay, gastrointestinal hemorrhage, cholestasis, dystonia, encephalopathy, acute psychosis, Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, alopecia
Pharmacology
Repository corticotropin (ACTH) analog that stimulates the adrenal cortex to secrete cortisol, corticosterone, aldosterone, and weak androgens; also reported to bind melanocortin receptors, with the trophic effects on the adrenal cortex appearing to be mediated by cyclic AMP.
Vigabatrin is an irreversible inhibitor of gamma-aminobutyric acid transaminase (GABA-T), the enzyme responsible for the catabolism of the inhibitory neurotransmitter GABA, resulting in increased GABA levels in the central nervous system; the duration of effect is dependent on the rate of GABA-T enzyme re-synthesis rather than on the rate of drug elimination from the systemic circulation.
Enter your patient's insuranceCheck specific coverage details for your patient.
Most Common Insurance
Anthem BCBS
Acthar
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (1/12) · Qty limit (0/12)
Sabril
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (0/12) · Qty limit (11/12)
UnitedHealthcare
Acthar
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (0/8)
Sabril
- Covered on 4 commercial plans
- PA (8/8) · Step Therapy (0/8) · Qty limit (8/8)
Humana
Acthar
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (2/3) · Qty limit (2/3)
Sabril
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Acthar.
$10/momo
Sabril SHAREPlus Copay Assistance ProgramCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
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Next Steps for Your Patient
ActharView full Acthar profile
SabrilView full Sabril profile
Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.