(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 you immune system to lessen joint
- 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),
such as 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.
The Food and Drug
Administration approved abatacept for 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. Generally, DMARDs are tried initially. Abatacept
may be used alone or in combination with DMARDs, which gives it more potency,
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
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.
formulation 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
patients feel relief within the first month of treatment, generally it takes
three months of uninterrupted therapy to obtain the full effect of the
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 that is rapid in onset –has
been reported 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 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
The most important
side effect is the risk of developing a serious infection, including pneumonia,
tuberculosis and others. Therefore, patients are tested for possible
tuberculosis with a skin test or blood test before starting this drug.
Abatacept should not be used together with other biologic therapy 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.
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.
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 having symptoms of 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.
Points to remember
- Abatacept is unique among the biologic drugs in
terms of how it works. It is generally
prescribed after other drugs (including DMARDs) have failed.
- 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.
To find a
rheumatologist near you, visit ww2.rheumatolgy.org/directory.
You can also learn more about rheumatologists and other rheumatology health
professionals in the Patient Resources section of www.rheumatology.org.
Updated March 2015 by Kelly
Weselman, MD, and reviewed by the American College of Rheumatology Communications
and Marketing Committee. This patient fact sheet 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
© 2015 American College of