II. Indications
- Refractory, moderate to severe Rheumatoid Arthritis
- Active Rheumatoid Arthritis
- Juvenile Idiopathic Arthritis (JIA, moderate to severe)
III. Contraindications
- Do not use with TNF Inhibitors, Anankira, Tofacitinib
- Do not use with Live virus Vaccine 3 months before, during or 3 months after last dose
- Update Vaccinations (both live and passive) before starting Abatacept
- Stop Abatacept if serious infection occurs
IV. Mechanism
- Abatacept is a fusion Protein of a receptor bound to the IgG Fc fragment (similar to Etanercept)
- Extracellular CTLA4 fused to IgG Fc of IgG1
- IgG Fc Fragment
- Abatacept is a T-Cell Co-Stimulatory Blocker
- T-Cells are stimulated via CD3 with co-stimulation via various agents including CD28
- Abatacept inhibits CD28 to CD80/CD66 binding
- CD28 Inhibition
- Increases T-Cell Activation threshold and inhibits T-Cell proliferation
- Images
- T-Cells are stimulated via CD3 with co-stimulation via various agents including CD28
V. Medications
-
General
- Keep refrigerated until 30 to 60 min before injection
- Protect from light
- Formulations
- Autoinjector: 125 mg/ml (adults or weight >=50 kg)
- Prefilled syringes: 50 mg/0.4 ml, 87.5 mg/0.7 ml, 125 mg/ml
- Intravenous infusion
- Administration
- Allow to warm to room Temperature for 30 to 60 minutes before injection
- Subcutaneous Injection is in thigh, Abdomen or outer upper arm
VI. Dosing: Adult
- Intravenous (IV)
- IV infusion: 10 mg/kg to 500, 750 or 1000 mg over 30 minutes
- Weight <60 kg: 500 mg
- Weight 60 to 100 kg: 750 mg
- Weight >100 kg: 1000 mg
- IV Dosing Interval
- Give at 0, 2 and 4 weeks and then every 4 weeks (or transition to SQ dosing)
- IV infusion: 10 mg/kg to 500, 750 or 1000 mg over 30 minutes
- Subcutaneous (SQ)
- Give 125 mg SQ weekly in thigh, Abdomen or outer upper arm
- Transitioning from IV to SQ dosing
- Give on the next day after the first IV dose OR
- At the next scheduled IV dose after regular IV dosing
VII. Dosing: Child
- Indicated for Juvenile Idiopathic Arthritis
- Intravenous (IV, age 6 years and older)
- Use adult dose (see above) for weight >=75 kg
- IV infusion: 10 mg/kg up to maximum of 1000 mg over 30 minutes
- Give at 0, 2 and 4 weeks and then every 4 weeks (or transition to SQ dosing)
- Subcutaneous (SQ, age 2 years and older)
- Weight 10 to 25 kg: 50 mg
- Weight 25 to 50 kg: 87.5 mg
- Weight >=50 kg: 125 mg
VIII. Pharmacokinetics
- Half-Life: 13 to 17 days
IX. Adverse Effects
- Hypersensitivity (including Anaphylaxis)
- Serious infections
- Higher risk of pulmonary infections in comorbid COPD
- Latent infection reactivation
- Tuberculosis reactivation
- Hepatitis BVirus Infection reactivation
- Cytomegalovirus (CMV) Reactivation
- Epstein-Barr Virus (EBV) Reactivation
- Common
X. Safety
- Unknown safety in pregnancy
- Avoid in Lactation
XI. Drug Interactions
XII. Resources
- Abatacept Injection Solution (DailyMed)
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Related Studies
| orencia (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ORENCIA 125 MG/ML SYRINGE | $1,231.29 per ml | |
| ORENCIA CLICKJECT 125 MG/ML | $1,230.50 per ml | |