ACTH for Fatigue in Multiple Sclerosis Patients

Inclusion Criteria

• Have documented diagnosis of Relapsing MS as defined by McDonald Criteria 2011 Revision for at least 6 months
• Have been treated with interferon beta 1a or 1b, glatiramer acetate, fingolimod, dimethyl fumarate, or teriflunomide for at least 6 months, with reported adherence rate of at least 75%, at time of screening
• Have an Kurtzke Expanded Disability Status Scale (EDSS) score of 0 to 4, inclusive
• Have Modified Fatigue Impact Scale (MFIS) ≥ 38 or Functional Systems Scores (FSS) ≥ 36, Beck Depression Inventory-II (BDI-II) greater than or equal to 19, and Expanded Disability Status Scale (EDSS) greater than or equal to 9
• Women of childbearing potential must employ proven methods to prevent pregnancy during the course of the trial
• Able to understand the purpose and risks of the study
• Must be willing to sign an inform consent
• Must be willing to follow the protocol requirements
• Subject must agree not to receive any live or live-attenuated vaccine during the trial

Exclusion Criteria

• Have any of the contraindications for Acthar Gel as listed in the approved label, including sensitivity to proteins of porcine origin.
• Had treatment of systemic or oral corticosteroids of any type in 90 days prior to baseline/randomization
• Had a relapse or documented objective neurologic worsening in 90 days prior to baseline/randomization
• Has concurrent neurological disease other than multiple sclerosis
• History of sleep apnea
• History (within 90 days) of nocturnal pain and / or nocturnal spasms that interferes with or disrupts sleep, or uncontrolled nocturnal restless leg syndrome
• History of psychosis, bipolar disorder, mania/hypomania
• History of coronary heart disease, congestive heart failure, chronic pulmonary disease, emphysema, anemia, bleeding disorder, gastrointestinal bleeding, intestinal ulcer, clinically significant cardiac arrhythmia, Type I or II diabetes, uncontrolled hypertension, seizure disorder, cardiac arrhythmia, immune deficiency disorder, HIV-AIDS, tuberculosis, or dysthyroidal state (patients with a history of hypothyroidism or hyperthyroidism, which has been corrected to physiological levels will not be excluded)
• History of substance abuse, other than tobacco within the past 5 years or current alcohol dependence
• Current use of cannabis, opiates, benzodiazepines, barbiturates, gabapentin, pregabalin, topiramate, divalproex sodium, carbamazepine, oxcarbazepine, or any gaba-ergic medications other than tizanidine or Baclofen, which are permitted for spasticity treatment
• History of any malignant neoplasm except for past basal cell or squamous cell carcinoma of the skin, that has been successfully treated prior to the screening visit
• History of psychosis or history of use of neuroleptics including, but not restricted to, haloperidol, chlorpromazine, aripiprazole, olanzapine, risperidone
• History of suicide attempt, current suicidal thinking or is preparing for suicide
• Current use of Amphetamines or methylphenidate
• Current use of modafinil, or armodafinil
• Current use of amantidine
• The subject must have had a medication-free interval of:

a. 7 days for prior use of: i. methylphenidate, amphetamine or dextroamphetamine ii. modafinil or armodafinil iii. diphenhydramine, phenylephrine, loratadine iv. gabapentin, pregabalin, topiramate, valproate/divalproex v. oxcarbazepine vi. codeine, hydrocodone, oxycodone, diphenhydramine, phenylephrine, gabapentin, pregabalin, topiramate, valproate/divalproex, oxcarbazepine, codeine, hydrocodone, oxycodone b. 14 days for prior use of: i. desloratadine ii. Amantidine iii. alprazolam, lorazepam, morphine, hydromorphone, amantidine, alprazolam, lorazepam iv. morphine, hydromorphone c. 28 days for prior use of: i. clonazepam ii. cannabis or other cannabinoids d. 90 days for prior use of carbamazepine