| Nephrotic Syndrome
Acthar vs Flexbumin 25%
Side-by-side clinical, coverage, and cost comparison for nephrotic syndrome.Deep comparison between: Acthar vs Flexbumin 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 signalsFlexbumin has a higher rate of injection site reactions vs Acthar based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Flexbumin but not Acthar, including UnitedHealthcare
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Category
Acthar
Flexbumin
At A Glance
IM or SC injection
Corticotropin analog
IV infusion
Human albumin / plasma volume expander
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
- Hypoalbuminemia
- Respiratory Distress Syndrome, Adult
- Nephrotic Syndrome
- Erythroblastosis, Fetal
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.
Hypovolemic Shock Infants and young children: 2.5 to 5 mL per kg body weight IV; older children and adults: initial dose 100 to 200 mL IV, repeated after 15 to 30 minutes if response is inadequate. Do not exceed 1 mL/min in patients with normal blood volume.
Hypoalbuminemia Calculate body albumin compartment to be 80 to 100 mL per kg body weight; do not exceed a daily dose of 2 g of albumin per kg of body weight, administered IV.
Burns Dose determined by patient's condition and response to treatment after the first 24 hours, administered IV.
Erythroblastosis, Fetal 1 g per kilogram body weight IV prior to or during exchange transfusion.
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
- History of hypersensitivity reaction to albumin preparations or to any excipient (N-acetyltryptophan and sodium caprylate)
- Severe anemia or cardiac failure with normal or increased intravascular volume
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
Serious Hypersensitivity reaction, anaphylactic reaction, pulmonary edema
Postmarketing Anaphylactic shock, anaphylactic reaction, hypersensitivity/allergic reactions, headache, dysgeusia, myocardial infarction, atrial fibrillation, tachycardia, hypotension, flushing, pulmonary edema, dyspnea, vomiting, nausea, urticaria, rash, pruritus, pyrexia, chills
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.
Human albumin accounts for 70 to 80% of the colloid osmotic pressure of normal plasma and serves as a transport protein; administered as a 25% IV solution, it draws approximately 3.5 times its volume of additional fluid into the circulation within 15 minutes, expanding blood volume.
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)
Flexbumin
- Covered on 5 commercial plans
- PA (6/12) · Step Therapy (0/12) · Qty limit (0/12)
UnitedHealthcare
Acthar
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (0/8)
Flexbumin
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Acthar
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (2/3) · Qty limit (2/3)
Flexbumin
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (0/3) · Qty limit (0/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Acthar.
No savings programs available for Flexbumin.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.