Abatacept (Orencia)

Medicine Vials

Abatacept (Orencia) is a biologic drug approved for the treatment of moderate to severe rheumatoid arthritis (RA) in adults, as well as Juvenile Rheumatoid Arthritis. These are inflammatory joint conditions causing joint pain, swelling, redness and morning stiffness. The drug decreases the interactions of T cells and B cells within the immune system to lessen joint inflammation.

Fast Facts

  • Abatacept is prescribed for treatment of moderate to severe rheumatoid arthritis. It is often prescribed after failure of a disease-modifying anti-rheumatic agent (DMARD), like methotrexate but it can be used as first-line therapy.
  • There is a higher risk of infections in patients taking abatacept, which is similar to that seen with other biologic medications.
  • Some forms of cancer have been reported in patients taking abatacept. Larger study groups and long-term study will clarify whether this is related to abatacept. Risks in pregnant women are still being studied.
  • Abatacept is unique among the biologic drugs in terms of how it works. It is generally prescribed after other drugs (including DMARDs) have failed but can be used as a first line therapy.
  • Long-term side effects are still being monitored. Safety was proven in different studies; however, you should report any unexpected symptom experienced while on this drug therapy.
  • Because biologics tend to be expensive, its availability may depend on your insurance formulary. Interruptions in treatment can lead to increased joint symptoms.
  • Sustained and better relief of symptoms may be experienced the longer abatacept is used. After 2 years of uninterrupted use, patients reported less inflammation.

Uses

The Food and Drug Administration approved abatacept for the treatment of rheumatoid arthritis in 2005 and for children 6 years and older who have juvenile idiopathic arthritis in 2008. Studies with abatacept for the treatment of additional conditions are underway. Abatacept is used to reduce inflammatory symptoms such as swelling, pain and stiffness. In the long term, it is expected to stop joint deformities, therefore helping to maintain range of motion.

It is often used in patients with moderate to severe rheumatoid arthritis who have not responded to one or more DMARDs, such as methotrexate, or other biologic drugs. DMARDs are generally tried first. Abatacept may be used alone or in combination with DMARDs, which makes it more potent, but not with other biologic drugs (such as TNF-alpha blockers). Its use in other diseases is still being studied.

How it works

Unlike some other biologic drugs, abatacept does not block inflammatory proteins like TNF-alpha antagonists. Abatacept attaches to the surface of inflammatory cells and blocks communication between these cells. By blocking this communication, abatacept lessens inflammation.

Dosing

Abatacept is available either in infusible or injectable form. The infusion is given intravenously (through a needle placed in a vein) at 0, 2, and 4 weeks, then monthly thereafter in your doctor's office or at an infusion center. The dosage is adjusted according to the patient’s weight. It takes 30 minutes to receive the whole infusion.

The injectable form of abatacept is injected under the skin at home once a week. It can be administered by the patient or another member of the home. Studies have shown this formulation to be as safe and effective as the infusion.

Time to effects

Although some patients feel relief within the first month of treatment, usually three months of continuous treatment are needed to get the full effect of the medication.

Side effects

The most common side effects reported were those associated with headaches, common colds, sore throat and nausea. Children may have diarrhea, cough, fever and abdominal pain. Rare infusion reactions have been reported while administering abatacept including, anaphylaxis (a severe allergic reaction rapid in onset, occurring in less than 0.5 percent of patients), hives, shortness of breath or low blood pressure (has been reported in less than 1 percent of patients). Nurses will monitor you and your vital signs throughout the infusion. Pre-medications such as Tylenol or Benadryl can be used preventively and can be discussed with your doctor.

The most important side effect is the risk of developing a serious infection, including pneumonia, tuberculosis and others. Patients are tested for possible tuberculosis with a skin test or blood test before starting this drug. Abatacept should not be combined with another biologic drug, because the combination can increase the risk of contracting a serious infection.

It is not yet clear if the risk of cancer is higher in patients on abatacept compared to patients with other drugs. Nevertheless, larger reports should demonstrate if there is any trend of possible cancer risk.

Patients should not receive live vaccines while receiving abatacept and should be off of the medication before and after a live vaccine is administered.

Monitoring by your rheumatologist is necessary while taking this medication, and lab monitoring may be needed periodically as well.

Drug interactions

Using two biologic drugs (such as TNF-alpha blockers and abatacept) at the same time carries high risk of developing serious infections. Patients who have previously received another biologic drug, such as a TNF-alpha blocker, can receive abatacept after the first drug has been stopped.

Patients with diabetes mellitus should be aware that sugars in the infusion form of abatacept may cause false high blood sugar levels. You should discuss with your physician how to properly monitor this.

Information to discuss with other health care providers

Patients who have been exposed to people with suspected serious infections, such as tuberculosis, should notify their doctors and ask them about the TB skin test before starting or continuing abatacept. Other laboratory tests may be required as well. Patients displaying symptoms of an infection — including fever, cough or others — should notify their doctors.

Patients should not receive live vaccines while receiving abatacept and should consult their rheumatologist before receiving a live vaccine afterwards.

Women who are taking abatacept should discuss birth control methods with their primary doctor or gynecologist. Abatacept should not be given to pregnant women.

Updated March 2015 by Kelly Weselman, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee. This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.


© 2015 American College of Rheumatology