Form 8-K

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

WASHINGTON, D.C. 20549

 

 

FORM 8-K

 

 

CURRENT REPORT

PURSUANT TO SECTION 13 OR 15(d) OF THE

SECURITIES EXCHANGE ACT OF 1934

Date of Report (Date of earliest event reported): February 16, 2012

 

 

QUESTCOR PHARMACEUTICALS, INC.

(Exact Name of Registrant as Specified in Charter)

 

 

 

California   001-14758   33-0476164

(State or Other Jurisdiction

of Incorporation)

 

(Commission

File Number)

 

(I.R.S. Employer

Identification No.)

1300 Kellogg Drive, Suite D, Anaheim,

California

  92807
(Address of Principal Executive Offices)   (Zip Code)

Registrant’s telephone number, including area code: (714) 786-4200

 

 

Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions:

 

¨ Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425)

 

¨ Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12)

 

¨ Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b))

 

¨ Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c))

 

 

 


Item 7.01. Regulation FD Disclosure.

Commencing on February 16, 2012, Questcor Pharmaceuticals, Inc. (the “Company”) will utilize an updated presentation for investor relations purposes. The presentation includes the following update regarding prescription information for the Company’s primary product, H.P. Acthar Gel (repository corticotropin injection) (“Acthar”) for January 2012, based on the most recent data available to the Company at the time of this filing:

 

   

For acute exacerbations of multiple sclerosis (“MS”), the number of paid prescriptions was between 330 and 345 for January 2012.

 

   

For proteinuria in nephrotic syndrome of the indiopathic type (“NS”), the number of paid prescriptions was between 70 and 75 for January 2012.

 

   

For infantile spasms (“IS”), the number of paid prescriptions was between 45 and 50 for January 2012.

The Company is also disclosing the following unaudited balance sheet information as of January 31, 2012:

 

   

Cash, cash equivalents and short-term investments: $214 million.

 

   

Accounts receivable: $45 million

Risk Factor Regarding Volatility of Prescription Levels

The number of paid prescriptions for Acthar in each therapeutic area is volatile and the Company cautions investors to not view data for a single month or a single quarter as representative of a trend or otherwise being predictive of future results. The Company believes that investors should consider the Company’s results over several quarters when analyzing the Company’s performance.

Important, Previously Disclosed Information Regarding Prescriptions and Net Sales

Net sales of Acthar are derived from the Company’s sales of vials to CuraScript Specialty Distributor (“CuraScript SD”), which in turn sells Acthar primarily to specialty pharmacies. These specialty pharmacies place orders to CuraScript SD based on their respective levels of sales and inventory practices. End-user demand for Acthar results from physicians writing prescriptions to patients for the treatment of MS exacerbations, NS, IS and various other conditions. Physicians do not purchase Acthar for resale to patients. Instead, patients purchase Acthar directly from specialty pharmacies after receiving a prescription and, typically, arranging for third party reimbursement (government or commercial insurance) – often after satisfying a prior authorization requirement imposed by their insurance carrier.

Recommended treatment regimens among physicians prescribing Acthar vary within each therapeutic area. Due to various factors, including inventory levels at both the specialty pharmacies and at CuraScript SD, the duration of treatment regimens and the timing of the placement of refill prescription orders, there is typically a delay between changes in prescription levels and changes in the levels of orders the Company receives from CuraScript SD. Additionally, treatment regimens, and patient compliance with physician-recommended treatment regimens, may vary over time.

The Company’s ability to accurately determine the number of prescriptions is subject to the following important notes:

(1) Because Acthar prescriptions are filled at specialty pharmacies, the Company does not receive complete information regarding either the number of prescriptions or the number of vials by therapeutic area for all of the patients being treated with Acthar. However, the Company is able to monitor trends in payer mix and areas of therapeutic use for new (non-refill) Acthar prescriptions based on data the Company receives from its reimbursement support center. The Company estimates that over 90% of new Acthar prescriptions are processed by this support center, but believes that very few refill prescriptions are processed there.

(2) Prescription figures include related conditions for each therapeutic area. Related conditions are diagnoses that are either alternative descriptions of the medical condition or are closely related to the medical condition


referenced above. For example, a prescription for “Demyelinating disease of the central nervous system” would be included as an MS-related condition for purpose of the updated prescription information provided above. About 5% of the prescriptions referenced for a specific indication are for related conditions.

(3) A new prescription may or may not represent a new patient or a new therapy for the patient receiving the prescription. The Company uses business rules to determine whether a prescription should be classified as new for counting purposes. From time to time, the Company may modify these rules.

The presentation is furnished under this Item 7.01 pursuant to Regulation FD and is included as Exhibit 99.1 to this Current Report on Form 8-K. The presentation will also be made available on the Company’s website at www.questcor.com. In accordance with General Instruction B.2. of Form 8-K, the information in this Current Report on Form 8-K, including Exhibit 99.1, shall not be deemed “filed” for purposes of Section 18 of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), or otherwise subject to the liability of that section, nor shall it be deemed incorporated by reference in any filing under the Securities Act of 1933, as amended, or the Exchange Act, except as expressly set forth by specific reference in such a filing.

 

Item 9.01. Financial Statements and Exhibits.

 

(d) Exhibits.

 

Exhibit No.    Description
99.1    Questcor Pharmaceuticals, Inc. Investor Presentation dated February 16, 2012.


SIGNATURE

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized.

 

Date: February 16, 2012

    QUESTCOR PHARMACEUTICALS, INC.
  By:  

/s/ Michael Mulroy

    Michael Mulroy, Chief Financial Officer &
    General Counsel


EXHIBIT INDEX

 

Exhibit No.

  

Description

99.1    Questcor Pharmaceuticals, Inc. Investor Presentation dated February 16, 2012.
Questcor Pharmaceuticals, Inc. Investor Presentation
1
1
February 16, 2012
Leerink Swann
NASDAQ:
QCOR
NASDAQ:
QCOR
Exhibit 99.1


2
Safe Harbor Statement
Except for the historical information contained herein, this presentation contains forward-looking statements that are based
on management's current expectations and beliefs and are subject to a number of risks, uncertainties and assumptions that
could cause actual results to differ materially from those described.  All such statements have been made pursuant to the
Private Securities Litigation Reform Act of 1995, as amended. These statements relate to future events or our future financial
performance. In some cases, you can identify forward-looking statements by terminology such as "may," "will," "if," "should,"
"forecasts," “intends,” “exploring,” "expects," "plans," “appears,” “grows,” "believes," "estimates," "predicts," "potential,"
"continue" or “trends” or the negative of such terms and other comparable terminology. These statements are only
predictions. Actual events or results may differ materially. Factors that could cause or contribute to such differences include,
but are not limited to, the following: Our reliance on Acthar for substantially all of our net sales and profits; Reductions in vials
used per prescription resulting from changes in treatment regimens by physicians or patient compliance with physician
recommendations;  The complex nature of our manufacturing process and the potential for supply disruptions or other
business disruptions; The lack of patent protection for Acthar; and the possible FDA approval and market introduction of
competitive products; Our ability to generate revenue from sales of Acthar to treat on-label indications associated with NS,
and our ability to develop other therapeutic uses for Acthar including SLE; Research and development risks, including risks
associated with Questcor's work in the area of nephrotic syndrome and potential work in the area of SLE, and our reliance on
third-parties to conduct research and development and the ability of research and development to generate successful results;
Regulatory changes or other policy actions by governmental authorities and other third parties in connection with U.S. health
care reform or efforts to reduce federal and state government deficits; Our ability to receive high reimbursement levels from
third party payers; An increase in the proportion of our Acthar unit sales comprised of Medicaid-eligible patients and
government entities; Our ability to estimate reserves required for Acthar used by government entities and Medicaid-eligible
patients  and the impact that unforeseen invoicing of historical Medicaid prescriptions may have upon our results; Our ability
to operate within an industry that is highly regulated at both the Federal and state level; Our ability to effectively manage our
growth, including the expansion of our NS selling effort, and our reliance on key personnel; The impact to our business caused
by economic conditions; Our ability to protect our proprietary rights; Our ability to maintain effective controls over financial
reporting; The risk of product liability lawsuits; Unforeseen business interruptions; Volatility in Questcor's monthly and
quarterly Acthar shipments and end-user demand, as well as volatility in our stock price; and Other risks discussed in
Questcor's annual report on Form 10-K for the year ended December 31, 2010, and other documents filed with the Securities
and Exchange Commission.
The risk factors and other information contained in these documents should be considered in evaluating Questcor's prospects
and future financial performance.


3
A biopharmaceutical company whose
product, Acthar, helps patients with serious,
difficult-to-treat medical conditions
A biopharmaceutical company whose
product, Acthar, helps patients with serious,
difficult-to-treat medical conditions
Questcor


4
Flagship Product:
Flagship Product:
Profitable, cash flow positive, $214M** in cash, debt-free
Profitable, cash flow positive, $214M** in cash, debt-free
19 approved indications
19 approved indications
Key Markets*:
Key Markets*:
Multiple Sclerosis, Nephrotic Syndrome, Infantile Spasms
Several billion dollar market opportunity
Multiple Sclerosis, Nephrotic Syndrome, Infantile Spasms
Several billion dollar market opportunity
Strategy:
Strategy:
Continue to grow Acthar sales in each key market
Develop other on-label markets for Acthar
Continue to grow Acthar sales in each key market
Develop other on-label markets for Acthar
Financials:
Financials:
*In
this
presentation,
the
terms
“Multiple
Sclerosis,”
“Nephrotic
Syndrome”
and
“Infantile
Spasms,”
and
their
abbreviations,
refer
to
the
on-label
indications
for
Acthar
associated
with
such
conditions.
Investors
should
refer
to
the
FDA
approved
Acthar
label,
which
can
be
found
at
http://www.acthar.com/files/Acthar-PI.pdf
.
**As
of
01/31/12
Questcor Overview


5
Questcor Strategy -
Pursue Acthar Markets
Multiple Sclerosis (MS)
Multiple Sclerosis (MS)
Nephrotic Syndrome (NS)
Nephrotic Syndrome (NS)
Infantile Spasms (IS)
Infantile Spasms (IS)
Systemic Lupus Erythematosus
Systemic Lupus Erythematosus


6
Acthar and Multiple Sclerosis (MS)
Potential
target for
*Nickerson, et al (2011)
ACTHAR is approved for MS exacerbations, without reference to first line or second line use but is generally positioned as
second
line
as
a
matter
of
marketing
strategy.
See
http://www.acthar.com/files/Acthar-PI.pdf
for
details.
43% get better or
43% get better or
much better
much better
27% get only a
27% get only a
little better
little better
30% stay the same
30% stay the same
or get worse
or get worse
Neurodegenerative disorder
Acute treatment for relapses
Neurodegenerative disorder
Acute treatment for relapses


7
Notes: Historical trend information is not necessarily indicative of future results.  Acthar is marketed for the on-label indication of MS
exacerbations
in
adults,
though
the
chart
includes
"Related
Conditions"
-
diagnoses
that
are
either
alternative
descriptions
of
the
condition
or
are closely related to the medical condition which is the focus of the chart. About 5% of the prescriptions in the tables are for related conditions.
Yellow numbers in the  bars show the number of MS sales representatives making calls for the majority of the quarter.
Notes: Historical trend information is not necessarily indicative of future results.  Acthar is marketed for the on-label indication of MS
exacerbations
in
adults,
though
the
chart
includes
"Related
Conditions"
-
diagnoses
that
are
either
alternative
descriptions
of
the
condition
or
are closely related to the medical condition which is the focus of the chart. About 5% of the prescriptions in the tables are for related conditions.
Yellow numbers in the  bars show the number of MS sales representatives making calls for the majority of the quarter.
MS Scripts-Record of Consistent Growth
77
77
30
30
38
38
Paid Rxs
78
124
141
213
231
304
323
354
508
751
886
945
Q1 '09
Q2 '09
Q3 '09
Q4 '09
Q1 '10
Q2 '10
Q3 '10
Q4 '10
Q1 '11
Q2 '11
Q3 '11
Q4 '11


8
Monthly MS Scripts History
Notes: Historical trend information is not necessarily indicative of future results.  Acthar is marketed for the on-label indication of MS
exacerbations
in
adults,
though
the
chart
includes
"Related
Conditions"
-
diagnoses
that
are
either
alternative
descriptions
of
the
condition or
are closely related to the medical condition which is the focus of the chart. About 5% of the prescriptions in the tables are for related conditions.
Notes: Historical trend information is not necessarily indicative of future results.  Acthar is marketed for the on-label indication of MS
exacerbations
in
adults,
though
the
chart
includes
"Related
Conditions"
-
diagnoses
that
are
either
alternative
descriptions
of
the
condition or
are closely related to the medical condition which is the focus of the chart. About 5% of the prescriptions in the tables are for related conditions.
0
50
100
150
200
250
300
350
0
50
100
150
200
250
300
350
15-30
reps
30-38
reps
38-77
reps


9
Characterized by excessive spilling of protein
from the kidneys into the urine (proteinuria)
Can result in end-stage renal disease (ESRD),
dialysis, transplant
Acthar is approved “to induce a diuresis or a
remission of proteinuria in the nephrotic syndrome
without uremia of the idiopathic type or that due to
lupus erythematosus”
Significant unmet need
Few treatment options
Goal of therapy is the significant reduction
of proteinuria
Characterized by excessive spilling of protein
from the kidneys into the urine (proteinuria)
Can result in end-stage renal disease (ESRD),
dialysis, transplant
Acthar is approved “to induce a diuresis or a
remission of proteinuria in the nephrotic syndrome
without uremia of the idiopathic type or that due to
lupus erythematosus”
Significant unmet need
Few treatment options
Goal of therapy is the significant reduction
of proteinuria
Acthar and Nephrotic Syndrome (NS)


10
Paid Rxs
Paid Rxs
Yellow numbers in the  bars show the number of NS sales
representatives
making
calls
for
the
majority
of
the
quarter.
Q3
‘11
included expansion and training of new sales people.
NS Scripts-Strong Q4 Growth
5
5
28
11
4
8
7
18
45
60
146
Q1 '10
Q2 '10
Q3 '10
Q4 '10
Q1 '11
Q2 '11
Q3 '11
Q4 '11
Notes: Historical trend information is not necessarily indicative of future results.  Chart includes "Related Conditions" - diagnoses that
are either alternative descriptions of the condition or are closely related to the medical condition which is the focus of the chart.


11
FDA approval 10/15/10
Devastating, refractory form of childhood epilepsy
IS not responsive to standard anti-epileptic drugs
Unsuccessful treatment may leave infant with permanent
developmental disabilities
Considered a medical emergency
Ultra-rare orphan disorder
About half of IS patients receive Acthar via Acthar patient
support programs and Medicaid
FDA approval 10/15/10
Devastating, refractory form of childhood epilepsy
IS not responsive to standard anti-epileptic drugs
Unsuccessful treatment may leave infant with permanent
developmental disabilities
Considered a medical emergency
Ultra-rare orphan disorder
About half of IS patients receive Acthar via Acthar patient
support programs and Medicaid
Acthar and Infantile Spasms (IS)


12
Acthar currently used to treat 40-50% of IS patients
Targeting select institutions
Significant variability in quarterly Rxs
Q4-2011 paid Rxs above historic range
Acthar currently used to treat 40-50% of IS patients
Targeting select institutions
Significant variability in quarterly Rxs
Q4-2011 paid Rxs above historic range
IS Scripts-Higher numbers in H2 2011


13
High unmet need; difficult to treat
Serious health risk if unsuccessfully treated
Multiple on-label indications for Acthar
Exacerbations
Maintenance therapy
Lupus nephritis
Large patient population
High unmet need; difficult to treat
Serious health risk if unsuccessfully treated
Multiple on-label indications for Acthar
Exacerbations
Maintenance therapy
Lupus nephritis
Large patient population
Systemic Lupus Erythematosus (Lupus)


14
Profitable
Profitable
Debt Free
Debt Free
Cash Flow Positive
Cash Flow Positive
Financials


15
Q3 –
2011
Q3 –
2010
Net Sales ($M)
$59.8
$31.3
Gross Margin
94%
93%
Operating Income ($M)
$33.6
$16.8
Fully Diluted, GAAP EPS
$0.35
$0.18
Q3-2011 Financial Results
Third quarter vials shipped: 2,910
Third quarter cash flow from operations: $32.6M
Channel inventory estimated to be within historic range
Medicaid reserves continue to appear adequate
No shares repurchased
Third quarter vials shipped: 2,910
Third quarter cash flow from operations: $32.6M
Channel inventory estimated to be within historic range
Medicaid reserves continue to appear adequate
No shares repurchased
Record Net Sales (up 91%) and Solid Earnings (EPS up 94%)
Record Net Sales (up 91%) and Solid Earnings (EPS up 94%)


16
01/31/12
Cash / ST Investments
$214M*
Accounts Receivable
$45M
Questcor is Cash Flow Positive
*After return of $78 million of cash to shareholders through share repurchases.
*After return of $78 million of cash to shareholders through share repurchases.
Debt-free balance sheet
Debt-free balance sheet


17
2.2 Million Preferred share buyback
13.2 Common share buyback
$78 million returned to shareholders in stock buybacks
63.6
million shares currently outstanding
4.3 million shares remain on buyback authorization
2.2 Million Preferred share buyback
13.2 Common share buyback
$78 million returned to shareholders in stock buybacks
63.6
million shares currently outstanding
4.3 million shares remain on buyback authorization
Share Repurchases: 15 Million Shares
Repurchased shares  significantly improved EPS
Repurchased shares  significantly improved EPS


18
3,360 Vials Shipped
Net sales of approximately $75 million
Operating expenses expected to be up
20-30% from Q3-2011
Operating income of approximately $41 million to $43 million
Paid Rxs Q4-11 and January 2012 (estimated)
3,360 Vials Shipped
Net sales of approximately $75 million
Operating expenses expected to be up
20-30% from Q3-2011
Operating income of approximately $41 million to $43 million
Paid Rxs Q4-11 and January 2012 (estimated)
Preliminary Q4-2011 Metrics
DX
Q4-11
January 2012
MS
945
330-345
NS
146
70-75
IS
120
45-50
Notes:
Paid
Rx
information
based
on
internal
estimates.
The
table
includes
"Related
Conditions"
-
diagnoses
that
are
either
alternative
descriptions of the condition or are closely related to the medical condition which is the focus of the chart. About 5% of the prescriptions in the
tables are for related conditions.
Notes:
Paid
Rx
information
based
on
internal
estimates.
The
table
includes
"Related
Conditions"
-
diagnoses
that
are
either
alternative
descriptions of the condition or are closely related to the medical condition which is the focus of the chart. About 5% of the prescriptions in the
tables are for related conditions.


19
How Does Acthar Work?
Acthar treats autoimmune conditions across a variety of organ systems (CNS,
kidney, etc.)
Acthar appears to modulate the immune system and associated inflammatory
response through binding to melanocortin receptors
The
primary
melanocortin
peptide
(ACTH)
in
Acthar
binds
to
all
5
melanocortin
receptors (MCR1-5); other active peptides are in Acthar as well
Indirect effect:  Acthar triggers the production of cortisol and
other adrenal
compounds through binding to MCR2 receptors
Direct effect:  Acthar acts directly at the cellular level by binding to melanocortin
receptors on immune cells and cells in the targeted tissues (e.g., kidney podocytes)
All the active ingredients of Acthar have yet to be fully characterized and the
mechanism of action and pharmacokinetic profile of Acthar are not fully known
Acthar treats autoimmune conditions across a variety of organ systems (CNS,
kidney, etc.)
Acthar appears to modulate the immune system and associated inflammatory
response through binding to melanocortin receptors
The
primary
melanocortin
peptide
(ACTH)
in
Acthar
binds
to
all
5
melanocortin
receptors (MCR1-5); other active peptides are in Acthar as well
Indirect effect:  Acthar triggers the production of cortisol and
other adrenal
compounds through binding to MCR2 receptors
Direct effect:  Acthar acts directly at the cellular level by binding to melanocortin
receptors on immune cells and cells in the targeted tissues (e.g., kidney podocytes)
All the active ingredients of Acthar have yet to be fully characterized and the
mechanism of action and pharmacokinetic profile of Acthar are not fully known


20
Difficult/impossible to reverse engineer ACTHAR
Not well characterized
Complex pharmacology
Not well characterized
Clinical trial(s) required
Difficult/impossible to reverse engineer ACTHAR
Not well characterized
Complex pharmacology
Not well characterized
Clinical trial(s) required
Biosimilar Pathway Difficult/Impossible


21
Market
Rx Value
Market Size
MS
$40-50K
$1B+
NS
$150-250K
$1B+
IS
$100-125K
$100M
Lupus
Unknown
Unknown
Other
Various
Unknown
Total
$2B+
Acthar Market Opportunity


22
Market
Approximate
Annualized Net Sales
Run Rate*
Approximate
Annualized Level of
Business**
MS
$145-160M
$145-160M
NS
$60-70M
$100-110M
IS
$40-50M
$40-50M
NS Business Already Significant
Note: Figures do not represent actual net sales ranges for the quarter or year ended December 31, 2011
*
Figures
based
on
estimates
of
vials
shipped
to
patients
within
each
therapeutic
area
in
the
quarter,
multiplied
by
4.
** Figures represent Q4-2011 new paid prescriptions times estimated vials per script over treatment regimen, multiplied by 4.


23
Expand NS promotion effort
Expand MS promotion effort
Maintain IS promotion effort
Develop pilot rheumatology promotion activity
Develop other markets for Acthar
Acthar is its own pipeline with many other on-label indications
and many possible other therapeutic uses
Further define and develop the unique characteristics of Acthar
No unrelated business development efforts planned
Expand NS promotion effort
Expand MS promotion effort
Maintain IS promotion effort
Develop pilot rheumatology promotion activity
Develop other markets for Acthar
Acthar is its own pipeline with many other on-label indications
and many possible other therapeutic uses
Further define and develop the unique characteristics of Acthar
No unrelated business development efforts planned
Strategic Plan-
Focus on the Embedded Pipeline in Acthar


24
Sales Force Expansion-
Preliminary Outlook for 2012
Possible Rheumatology
Possible Rheumatology
Sales Pilot
Sales Pilot
Neuro Hiring &
Neuro Hiring &
Training
Training
Neuro
Neuro
Sizing &
Sizing &
Alignment
Alignment
Neph Hiring &
Neph Hiring &
Training
Training
Neph Sizing &
Neph Sizing &
Alignment
Alignment
Q1-12
Q1-12
Q2
Q2
Q3
Q3
Q4
Q4
Q1-13
Q1-13


25
Acthar has sustainable competitive
Acthar has sustainable competitive
advantages-without FDA approval risk
advantages-without FDA approval risk
Acthar is approved for 19 indications-many
Acthar is approved for 19 indications-many
in large markets with sizable unmet need
in large markets with sizable unmet need
Sales in MS and NS are growing rapidly,
Sales in MS and NS are growing rapidly,
yet market penetration is low
yet market penetration is low
Developing new vertical market -
Developing new vertical market -
Lupus
Lupus
High margins provide good
High margins provide good
operating leverage
operating leverage
Profitable, cash flow positive, no debt
Profitable, cash flow positive, no debt
Investment Highlights


26
26
February 16, 2012
Leerink Swann
February 16, 2012
Leerink Swann
NASDAQ:
QCOR
NASDAQ:
QCOR


27
ACTH is a Melanocortin Peptide Derived from
Pro-opiomelanocortin (POMC) in the Pituitary


28
MCR
Prevalent Tissue/Cells with Receptor
MC1R
Podocytes
Renal Mesangial Cells
Endothelial Cells (Glomerular, Tubular, Vascular)
Tubular Epithelial Cells
Macrophages
Melanocytes
Immune/Inflammatory Cells
Kerantinocytes
CNS
MC2R
Adrenal Cortex (Steroidogenesis), Adipocytes
Adapted from Gong 2011, Catania 2004, Schioth 1997
Affinity of Melanocortin Peptides and
Distribution of Receptor Subtypes


29
MCR
Prevalent Tissue/Cells with Receptor
MC3R
CNS
Macrophages
MC4R
Podocytes
Renal Mesangial Cells (?)
Endothelial Cells (Glomerular, Tubular)
Tubular Epithelial Cells
CNS
MC5R
CNS
Exocrine Glands
Lymphocytes
Podocytes
Adapted from Gong 2011, Catania 2004, Schioth 1997
Affinity of Melanocortin Peptides and
Distribution of Receptor Subtypes


30
MOA of
Acthar in NS
Adapted From Gong 2011
Acthar,
Melanocortin Peptides
Acthar,
Melanocortin Peptides