Abatacept for rheumatoid arthritis

Examples

Generic Name	Brand Name
abatacept	Orencia

Abatacept is given by injection (infusion) into a vein (intravenously) every 4 weeks.

How It Works

Abatacept is a man-made protein that interferes with T-cells. T-cells are part of your immune system and help cause inflammation and joint damage in rheumatoid arthritis. Abatacept affects rheumatoid arthritis by:

• Reducing symptoms.
• Slowing progression of joint damage.
• Reducing activity in the body's immune system.

Abatacept is a disease-modifying antirheumatic drug (DMARD), which means it slows the progression of rheumatoid arthritis. DMARDs are also called immunosuppressive drugs or slow-acting antirheumatic drugs (SAARDs).

Abatacept may be used alone or in combination with other DMARDs such as methotrexate. But abatacept is not used in combination with the other biologic DMARDs adalimumab (Humira), anakinra (Kineret), etanercept (Enbrel), and infliximab (Remicade).

Why It Is Used

Abatacept has been approved for use in adults with moderate to severe rheumatoid arthritis who have not been helped by one or more other medicines.

How Well It Works

Abatacept improves symptoms of rheumatoid arthritis in people who have not been helped by other medications. Abatacept slows the progression of joint damage caused by rheumatoid arthritis. Studies also showed that after abatacept treatment, people had better physical function.¹

Side Effects

Because abatacept is a protein that is injected (infused) into the vein, your body may have a reaction to the infusion. You will be given acetaminophen and diphenhydramine before infusions to prevent chills and light-headedness. But some people cannot adjust to the infusion and cannot tolerate the treatment. Although an infusion can be uncomfortable, frightening, and potentially serious, the effects can be treated and reversed rapidly.

During the infusion, you may have an infusion reaction, including:

• Body aches.
• Chills.
• Light-headedness.
• Nausea.
• Shortness of breath.

After the infusion, common side effects with abatacept include:

• Headache.
• Upper respiratory infection.
• Sore throat.
• Nausea.

Risk of infection

Abatacept decreases the activity of your body's immune system, which increases the risk of a serious bacterial infection. Some people who take abatacept will develop an infection that requires oral antibiotics; a smaller number of people will develop an infection that requires intravenous antibiotics and hospitalization. Contact your health professional if you develop any of the following symptoms:

• Fever or chills
• Increased frequency of or burning during urination
• A cough with yellow sputum or shortness of breath
• A skin infection
• Severe abdominal pain or diarrhea
• A severe sore throat
• Sinus pain with yellow mucus
• A painful, burning rash in a band across one side of your body (shingles)
• Painful, widespread mouth sores

Abatacept can reactivate tuberculosis (TB) in people who have been previously infected with TB. Before starting abatacept treatment, you should be screened with a tuberculin skin test and a chest X-ray. If the skin test is positive or the chest X-ray suggests previous exposure to TB, you will need treatment to prevent active TB.

People with rheumatoid arthritis have a slightly higher risk of getting cancer of the lymph glands, called lymphoma, than people without rheumatoid arthritis. But lymphoma is rare even for people with rheumatoid arthritis. Experts do not know why this risk is higher for people with rheumatoid arthritis—it may be because the disease is severe or because of the medicines used to treat it. Studies are currently under way to explain this. Talk with your doctor about the benefits and risks of DMARD therapy.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Abatacept should not be used by pregnant women or women of child-bearing age who are not using reliable birth control. If you are going to take abatacept, you should be on some form of reliable birth control. If you plan to become pregnant, check with your health professional before stopping birth control and trying to become pregnant.

Talk to your health professional before taking abatacept if you are breast-feeding because abatacept may pass into breast milk.

Talk to your health professional if you also have chronic obstructive pulmonary disease (COPD). Abatacept may cause more side effects in people with COPD.

Abatacept is given by an injection (infusion) into a vein (intravenously). An IV is inserted into your arm and the medicine is given slowly. An infusion takes about 30 minutes. You will take diphenhydramine and acetaminophen before the infusion to prevent reactions to the infusion, such as light-headedness or general discomfort.

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Author:	Carrie Henley Robin Parks, MS	Last Updated: October 13, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Tom Bailey, MD - Family Medicine Stanford M. Shoor, MD - Rheumatology
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