Abatacept (Orencia) is often prescribed after failure of a disease-modifying anti-rheumatic agent (DMARD), like methotrexate but it can be used as first-line therapy.
Abatacept is used to reduce inflammatory symptoms such as swelling, pain and stiffness. In the long term, it is expected to stop joint deformities to maintain range of motion. Abatacept can be used as first-line therapy, but it’s often prescribed to patients with moderate to severe rheumatoid arthritis, psoriatic arthritis, or moderate to severe polyarticular juvenile idiopathic arthritis who have not responded to one or more DMARDs, such as methotrexate. DMARDs, or disease modifying antirheumatic drugs, are generally tried as a first line agent to treat these conditions. Abatacept may be used alone or in combination with DMARDs, which makes it more potent, but not with other biologic drugs, such as TNF inhibitors. Its use in other diseases is still being studied.
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.
How to Take It
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. 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.
The most common side effects reported were those associated with headaches, common colds, sore throat, and nausea. Rarely, patients may develop infusion reactions while receiving abatacept including a severe allergic reaction, hives, shortness of breath, and low blood pressure. 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.
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.
Patients with diabetes mellitus should be aware that sugars in the infusion form of abatacept may cause false high blood sugar levels. Additionally, individuals with chronic obstructive pulmonary disease (COPD) should be monitored closely as the medication has been noted to increase the risk of COPD exacerbation. You should discuss with your physician how to properly monitor this.
Tell Your Rheumatology Provider
Patients who have been exposed to people with suspected serious infections, such as tuberculosis, should notify their rheumatology providers before taking Orencia. All patients should be tested for tuberculosis before starting abatacept. Other laboratory tests may be required as well. Patients displaying symptoms of an infection - including fever, cough, or others - should notify their rheumatology provider.
Patients should not receive live vaccines while receiving abatacept and should consult their rheumatologist before receiving a live vaccine afterwards.
Risks in pregnant women are still being studied.
Because biologics tend to be expensive, its availability may depend on your insurance formulary.
Updated February 2022 by Mohammad Ursani, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.
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.