abatacept

abatacept,

an antirheumatic agent.

indications This drug is used to treat acute or chronic rheumatoid arthritis that has not responded to other disease-modifying agents. It may be used in combination with other disease-modifying antirheumatic agents. It may not be used with tumor necrosis factor antagonists or anakinra.

contraindications Tuberculosis and known hypersensitivity to this drug prohibit its use.

adverse effects Adverse effects of this drug include headache, asthenia, dizziness, abdominal pain, dyspepsia, nausea, rash, flushing, urticaria, pruritus, and wheezing. Life-threatening side effects include anaphylaxis, malignancies, and angioedema. Common side effects include hypertension, hypotension, injection site reaction, pharyngitis, cough, rhinitis, and upper respiratory tract infection.

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abatacept

Orencia

Pharmacologic class: Selective costimulation modulator

Therapeutic class: Antirheumatic

Pregnancy risk category C

Action

Inhibits T-cell activation by binding to CD80 and CD86, blocking interaction with CD28. (This interaction triggers costimulatory signal necessary for full activation of T cells, which are implicated in rheumatoid arthritis pathogenesis).

Availability

Powder for infusion (lyophilized): 250 mg/15 ml in single-use vial

⊘Indications and dosages

➣ To reduce signs and symptoms, slow progression of structural damage, and improve physical function in patients with moderately to severely active rheumatoid arthritis who've responded inadequately to one or more disease-modifying antirheumatic drugs or tumor necrosis factor (TNF) antagonists (such as adalimumab, etanercept, or infliximab)

Adults weighing less than 60 kg (132 lb): 500 mg I.V. given over 30 minutes at weeks 0, 2, and 4; thereafter, give every 4 weeks

Adults weighing 60 to 100 kg (132 to 220 lb): 750 mg I.V. given over 30 minutes at weeks 0, 2, and 4; thereafter, give every 4 weeks

Adults weighing more than 100 kg: 1 g I.V. given over 30 minutes at weeks 0, 2, and 4; thereafter, give every 4 weeks

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:
• increased risk of infection or history of recurrent infections, immunocompromised state, chronic obstructive pulmonary disease (COPD)
• concurrent use of concomitant TNF antagonists
• patients older than age 65
• pregnant or breastfeeding patients
• children (safety and efficacy not established).

Administration

☞ Reconstitute each vial with 10 ml sterile water for injection, using only silicone-free disposable syringe included with product.
☞ During reconstitution, rotate vial by swirling gently. Avoid prolonged or vigorous agitation. Don't shake.
• Further dilute reconstituted solution to volume of 100 ml with normal saline solution.
• Use silicone-free syringe to add drug to infusion bag or bottle, and mix gently. Resulting drug concentration should be 5 mg/ml for two vials, 7.5 mg/ml for three vials, or 10 mg/ml for four vials, respectively.
• Administer infusion over 30 minutes using infusion set and nonpyogenic, low-protein-binding filter.
• Complete infusion within 24 hours of vial reconstitution.
• Don't infuse other drugs concurrently through same I.V. line.
• Watch for infusion-related reactions (hypotension or hypertension, dyspnea, nausea, dizziness, headache, flushing, urticaria, pruritus, rash, cough, or wheezing), which usually occur within 1 hour of administration. Be prepared to intervene appropriately.

Route	Onset	Peak	Duration
I.V.	Unknown	Unknown	Unknown

Adverse reactions

CNS: headache, dizziness

CV: hypertension, hypotension

EENT: nasopharyngitis

GI: nausea, dyspepsia, diverticulitis

GU: urinary tract infection, acute pyelonephritis

Musculoskeletal: back pain, extremity pain

Respiratory: cough, upper respiratory tract infection (including herpes zoster infection), pneumonia, wheezing, bronchitis, dyspnea

Skin: rash, flushing, urticaria, pruritus

Other: malignancies, infusion-related reactions, hypersensitivity reaction

Interactions

Drug-drug. Immunizations: possible decrease in immunization efficacy

Patient monitoring

• Continue to monitor patient for infusion-related events.
• Assess patient's overall health at each visit to evaluate infection status.
• Closely monitor COPD patient because of increased likelihood of adverse events.

Patient teaching

• Instruct patient to report signs and symptoms of infection.
• Caution patient to avoid immunizations during or within 3 months of stopping drug.
• Tell female with childbearing potential that pregnancy and breastfeeding aren't recommended during therapy.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs mentioned above.