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We assessed the efficacy and safety of repository corticotropin injection (RCI; Acthar Gel) for persistently active systemic lupus erythematosus (SLE) despite use of moderate-dose glucocorticoids. This multicenter, double-blind, randomized, placebo-controlled study enrolled patients ≥ 18years with active SLE and moderatetosevere rash and/or arthritis despite stable glucocorticoid doses (7.5-30mg/day prednisone equivalent) and antimalarials for ≥ 4weeks and/or immunosuppressants for ≥ 8weeks before screening. Stable glucocorticoid doses were required through