Abatacept

Abatacept is used to treat inflammatory types of arthritis, such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), juvenile idiopathic arthritis (JIA), and juvenile rheumatoid arthritis (JRA).

For the treatment of RA, abatacept may be used as monotherapy or in combination with DMARD therapy, such as methotrexate (MTX). In recently diagnosed patients who have not been previously treated with MTX, abatacept should be given in combination with MTX (unless MTX cannot be taken).

Abatacept is delivered through infusion once a month or via subcutaneous (s.c.) injection (meaning injection with a needle in the fatty layer of tissue just under the skin) once a week. Subcutaneous injections can be administered at home either by the patient themselves or by a caregiver. Intravenous infusions can be administered in an infusion clinic.

When given by infusion the dose of abatacept depends on your body weight, but a typical dose ranges from 500 to 1,000 mg once a month, and a loading dose is often given every 2 weeks initially. After your first infusion you will receive your second dose on week 2, and your third dose on week 4. Your maintenance dose will be started 4 weeks later and will be given every 4 weeks from then on. The medication comes in a single-use vial for administration by infusion. Each infusion takes about 30 to 60 minutes.

When given by s.c. injection, the dose of abatacept is 125 mg weekly. The medication may come as a single-use pre-filled syringe or autoinjector for administration. Some people may require an initial infusion loading dose prior to starting abatacept by s.c. injection.

Abatacept pre-filled syringes and autoinjectors cannot be used for infusions. Single-use vials for infusions cannot be used for s.c. injections.

Arthritis is caused by the immune system attacking tissues in the body. Abatacept works by suppressing the body’s immune system, specifically it prevents T-cells, a type of immune cell, from becoming activated and attacking the body’s own tissues. By doing this, abatacept can help to reduce pain and swelling in the joints, improve day-to-day function, and prevent long term damage to the joints.

As with all of the biologics, you may not feel the effects of abatacept right away. Some people begin to feel the effects of the medication in six to eight weeks; however, it may take three to six months to feel its full effect. It is important to be patient and keep taking your medication.

To provide symptom relief while you are waiting for abatacept to take effect, your healthcare provider may recommend taking a steroid, such as prednisone, or a non-steroidal anti-inflammatory drug (NSAID).

Taking abatacept can make it more difficult for your body to fight infections. Therefore, people with active infections should not take abatacept. If you have a fever, think you have an infection or have been prescribed an antibiotic, contact your healthcare provider. People who have had frequent infections in the past or a history of tuberculosis should discuss the use of abatacept with their healthcare provider.  Also, contact your healthcare provider if you are having surgery as you may need to stop abatacept until you are healed and there is no sign of infection.

Abatacept has not been studied in pregnant people or lactating parents so its effect(s) on pregnant people or nursing babies are unknown. You should tell your doctor if you are pregnant or are planning to become pregnant. Because of the potential for adverse reactions in nursing infants, a decision should be made with your healthcare provider on whether or not to discontinue nursing or the medication, taking into account the importance of the drug to the lactating parent.

Anyone who has had a previous allergic reaction to abatacept should avoid the medication.
People with a history of cancer or emphysema should discuss the use of abatacept with their healthcare provider.

Before starting this medication, you will likely be tested for inactive (“latent”) tuberculosis (TB) and hepatitis B because abatacept can dampen the immune system and cause these infections to become active. If TB or hepatitis is found, it will need to be treated before you start abatacept. 

Make sure that your vaccinations are up to date before starting abatacept. Your healthcare provider will likely recommend a number of vaccines (e.g., influenzae, pneumonia, RSV, shingles) to get beforehand. Because abatacept can decrease your ability to respond to vaccines, you should wait at least two to three weeks after your last vaccine before starting abatacept. If you are already on abatacept and need a vaccination, talk to your healthcare provider about vaccine spacing and whether or not you need to hold abatacept.  Live vaccines are not recommended due to risk of causing infection. Before receiving any vaccinations while taking abatacept, you should speak with your healthcare provider.

Like all medications, taking abatacept carries some risk of side effects, which must be balanced with the potential benefits. In general, the risk of joint damage and permanent disability (resulting from arthritis) is much greater than the risks of side effects from abatacept. When monitored properly, the vast majority of side effects are rare, most improve over time and are reversible.

Abatacept can increase your risk of infections. You should take precautions to minimize your risk of being infected by common contagious infections such as COVID-19, influenzae, pneumonia, and the common cold.

In rare cases, people may experience headaches, nausea, back pain and a rash while taking abatacept. If these symptoms become severe, please consult your healthcare provider.

Also in uncommon circumstances, abatacept can cause an allergic reaction during the infusion (flushing, itching, changes in heart rate and blood pressure, etc.). A healthcare provider will monitor for this reaction during the infusion. For people taking the medication by injection, abatacept can in rare instances cause an injection site reaction (redness, pain and itching). Talk to your healthcare provider if these symptoms become severe.

Take abatacept as prescribed and contact your healthcare provider if you have any concerns while taking the medication.

If you experience an infusion reaction while taking abatacept, prior to your next infusion your healthcare provider may recommend a medication pre-treatment to prevent a reaction. Your prescriber may also recommend a longer infusion time.

Keeping yourself well hydrated before getting your infusion and drinking while you get your infusion may also help reduce side effects.

To avoid injection reactions, injection sites should be rotated, and injections should never be given into areas where the skin is tender, bruised, red and/or hard.

Blood tests are not routinely required while you are taking abatacept. Your healthcare provider may order periodic blood tests to check your blood count and follow the activity of your arthritis.

Abatacept must be refrigerated at 2 to 8 degrees Celsius until you are ready to use it. Keep the product in the original package and out of the light.

Abatacept must be kept cool while travelling. Ask your pharmacist for a cool carrier if you are not able to put the drug in your refrigerator right away.

The patient support program for Orencia is called the “Orencia Response Program”. Their phone number is 1-877-979-3200.