IntravenousRheumatoid arthritisAdult: As monotherapy or in combination with methotrexate or other DMARDs: Initially, <60 kg: 500 mg; 60-100 kg: 750 mg; >100 kg: 1 g. Dose is given via infusion over 30 minutes, repeated at 2 and 4 weeks after 1st infusion, then every 4 weeks thereafter.
IntravenousJuvenile idiopathic arthritisChild: As monotherapy or in combination with methotrexate or other DMARDs: 6-17 yr <75 kg: 10 mg/kg via infusion over 30 minutes, repeated at 2 and 4 weeks after 1st infusion, then every 4 weeks thereafter; ≥75 kg Same as adult dose.
SubcutaneousRheumatoid arthritisAdult: 125 mg once weekly. If initiated with single IV infusion, administer 125 mg within the day of infusion followed by 125 mg once weekly.
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IV infusion: Add 10 mL sterile water for inj to a vial labelled as containing 250 mg to provide a soln containing 25 mg/mL. Swirl gently to avoid foaming. Dilute further w/ NaCl 0.9% inj to a total volume of 100 mL (withdraw a volume of NaCl equal to the volume of abatacept required), w/ a final concentration of ≤10 mg/mL. Do not shake.
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Hypersensitivity. Severe and uncontrolled infections (e.g. sepsis, active TB, hepatitis B, opportunistic infection). Lactation. Concomitant use w/ tumour necrosis factor (TNF) inhibitors and biologic immunosuppressive agents.
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Patient w/ COPD, history
of recurrent infections, underlying conditions that may predispose to
infections, or chronic, latent, or localised infections. Childn. Pregnancy. Admin of live
vaccines.
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Significant: Viral reactivation (i.e. hepatitis B), exacerbation of COPD.
Nervous: Dizziness, headache, fatigue, paraesthesia, depression, anxiety, vertigo.
CV: HTN, hypotension, flushing, arrhythmias.
GI: Nausea, dyspepsia, diarrhea, mouth ulcers.
Resp: Wheezing, dyspnoea, nasopharyngitis, cough, bronchitis.
Hepatic: Abnormal liver function values.
Haematologic: Thrombocytopenia, leucopenia.
Musculoskeletal: Back pain, pain in extremities.
Ophthalmologic: Conjunctivitis.
Dermatologic: Pruritus, rash, cellulitis, alopecia, psoriasis.
Others: Inj site reactions (e.g. haematoma, erythema, itch), infusion-related reactions.
Potentially Fatal: Serious infections (e.g. pneumonia, sepsis). Rarely, hypersensitivity, anaphylaxis, or anaphylactoid reactions.
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This drug may cause dizziness and reduced visual acuity, if affected, do not drive or operate machinery.
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Screen for hepatitis B and TB prior to initiation of therapy. Monitor CBC, ALT/AST, and creatinine before treatment. Monitor signs and symptoms of infections and hypersensitivity reaction.
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May diminish the therapeutic effect of live vaccines.
Potentially Fatal: Increased risk of serious infection w/ TNF inhibitors (e.g. adalimumab, etanercept, infliximab). Enhanced toxicity w/ biologic immunosuppressive agents (e.g. anakinra, rituximab).
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May result in falsely elevated blood glucose w/ dehydrogenase pyrroloquinolinequinone or glucose-dye-oxidoreductase tests on the day of infusion.
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Description:
Mechanism of Action: Abatacept is a selective costimulation modulator that binds to CD80 and CD86 on antigen presenting cells, which prevents activation of CD28 T-lymphocytes found in the synovium of rheumatoid arthritis patients, thus reducing cytokine production and inflammation.
Pharmacokinetics:
Absorption: Bioavailability: Approx 79% (SC; relative to IV).
Excretion: Terminal elimination half-life: Approx 13 days (IV); approx 14 days (SC).
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Store between 2-8°C. Protect from light. Do not freeze.
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Anon. Abatacept. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 02/06/2017. Buckingham R (ed). Abatacept. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/06/2017. Joint Formulary Committee. Abatacept. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/06/2017. McEvoy GK, Snow EK, Miller J et al (eds). Abatacept. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 02/06/2017. Orencia Injection, Powder, Lyophilized, For Solution (E.R. Squibb & Sons, L.L.C.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 02/06/2017.
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