abatacept (Orencia)
Jump to navigation
Jump to search
Introduction
Tradename: Orencia (FDA-approved 2005)
Indications
- FDA-approved for treatment of rheumatoid arthritis that does not respond adequately to methotrexate[3]
- rheumatoid arthritis with inadequate response to etanercept (Enbrel) or infliximab (Remicade)
- 50% response rate in clinical trial
- may be used concurrently with methotrexate or glucocorticoids
* preferred for patients with a history of severe infection[3]
Contraindications
- concurrent use of other biologic agent (TNF inhibitor, rituximab, anakinra)
- relatively contraindicated with COPD[3]
Dosage
- IV infusion over 30 minutes every 28 days, with additional dose on day 14
- subcutaneous: 125 mg SC injection in a prefilled syringe weekly[4]
* injection:
- 250 mg white lyophilized powder in a single-dose vial
- 125 mg/mL pack of 4 syringes with a passive needle safety guard[4]
Storage: refrigerate ar 2-8 C
Monitor
- screening for tuberculosis[3]
- CBC, LFTs, serum creatinine baseline & every 3-6 months thereafter
Adverse effects
- drug adverse effects of immunosuppressive agents
- drug adverse effects of biologic immunosuppressive agents
Drug interactions
- do NOT use in combination with Enbrel, Humira or Remicade combination increases risk of infaction without increase in benefit[2]
- drug interaction(s) of methotrexate with biological response modifier
- drug interaction(s) of biologic immunosuppressive agents
Mechanism of action
- soluble CTLA4 receptor/IgG Fc segment chimer
- inhibits T-cell activation
- targets CD80//CD86[3]
- diminishes production of TNF & other immune modulators
Management
- whenever possible bring patients up to date on vaccinations prior to initiating biologic immunosuppressive agent[3]
More general terms
References
- ↑ 1.0 1.1 Genovese MC et al. Abatacept for rheumatoid arthritis refractory to tumor necrosis factor alpha inhibition. N Engl J Med 2005 Sep 15; 353:1114-23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16162882
- ↑ 2.0 2.1 2.2 2.3 Prescriber's Letter 13(2): 2006 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220207&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2022.
- ↑ 4.0 4.1 4.2 4.3 ORENCIA. Information for Health Care Professionals https://www.orenciahcp.com/dosing-and-administration/intravenous https://www.orenciahcp.com/dosing-and-administration/subcutaneous