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ABATACEPT (Orencia), a selective costimulation modulator, inhibits T cell (T lymphocyte) activation by binding to CD80 and CD86, thereby blocking interaction with CD28. This interaction provides a costimulatory signal necessary for full activation of T lymphocytes. Activated T lymphocytes are implicated in the pathogenesis of RA and are found in the synovium of patients with RA.
In vitro, abatacept decreases T cell proliferation and inhibits the production of the cytokines TNF alpha (TNFα), interferon-γ, and interleukin-2. In a rat collagen-induced arthritis model, abatacept suppresses inflammation, decreases anti-collagen antibody production, and reduces antigen specific production of interferon-γ. The relationship of these biological response markers to the mechanisms by which abatacept exerts its effects in RA is unknown.
Patient Medication Guide
Full Prescribing Information
Abatacept is indicated for:
(If the answer is yes to any of these questions, review with ordering)
*Do not reconstitute abatacept vials until after obtaining intravenous access.*
Intravenous abatacept is provided as a lyophilized powder in preservative-free, single-use vials. Each abatacept vial provides 250 mg of abatacept for administration. After reconstitution, the concentration of abatacept in the vial is 25 mg/mL. If the abatacept powder is accidentally reconstituted using a silicon syringe, the solution may develop a few translucent particles. Discard any solutions prepared using silicon syringes.
For information on obtaining additional SILICONE-FREE DISPOSABLE SYRINGES, contact Bristol-Myers Squibb 1-800-ORENCIA.
Standard Infusion Checklist
Vital Signs Monitoring
Obtain vital signs (patient temperature, blood pressure and pulse) upon arrival prior to infusion, after the start of the infusion, upon discontinuing infusion, and before the patient departs the facility. If the patient has a prior history of an acute infusion reaction, monitor vitals every 10 minutes for 30 minutes and for 30 minutes after infusion. There is no need for vital signs to be done prior to subcutaneous injection of abatacept given by the patient at home.
Allow prefilled syringe to warm to room temperature (for 30 - 60 minutes) prior to administration. Inject into the front of the thigh (preferred), abdomen (except for 2-inch area around the navel), or the outer area of the upper arms (if administered by a caregiver). Rotate injection sites (≥1 inch apart); do not administer into tender, bruised, red, or hard skin.
Acute infusion reaction can occur during the administration of this agent or within one hour after the infusion. Patients may also have an infusion reaction the following day after the infusion. Anaphylactoid and anaphylaxis reactions can result from abatacept. If a patient reports mild reactions (such as dizziness, hives, flushing, chills, etc.), slow down the infusion rate and assess the patient. For more severe reactions (such as difficulty breathing, chest pain, high or low blood pressure, swelling of face and hands, fever, chills or anaphylaxis) or where mild reactions persist, stop the infusion and treat the acute reaction. Notify the supervising provider immediately to coordinate next plan of action. Patients should be informed that infusion reactions can be delayed, and should contact their physician at the first sign of an allergic reaction.
Perioperative Management of Medications Used in the Treatment of Rheumatoid Arthritis
Updated March 2018 - ARHP Practice Committee
The information contained in this biologic reference guide is offered solely for purposes of providing health care professionals with a quick and initial reference. Before prescribing or administering any drug contained in this biologic reference guide, health professionals should read the manufacturer’s complete prescribing information in order to be informed of the various clinical considerations to be taken into account. The American College of Rheumatology is providing this information as a benefit and service in furtherance of its educational mission. By providing this information, ACR is not endorsing or recommending any of the listed companies or any of their drugs or other products. The information contained in the biologic reference guides reflect the conclusions of the individual companies and not those of the ACR which specifically disclaims any responsibility or liability for the use of such information and/or for the performance of any of the drugs listed in this biologic reference guide.