What is Abatacept?

Why is abatacept prescribed?

What are the possible side effects?

What are the risks?

Will it affect vaccinations?

What else should I know about abatacept?

What is Abatacept?

Abatacept (trade name Orencia) is a type of drug called a biological therapy. It works by stopping the function of a particular cell in the immune system (called a T-cell). This prevents the inflammation and immune activity which cause the symptoms of rheumatoid arthritis. Abatacept has been shown to be very effective for treating the symptoms of rheumatoid arthritis in a variety of studies.

What type of drug is abatacept (trade name Orencia?)

Abatacept is a biological therapy.

What does it do?

It blocks T-cell function to reduce inflammation.

What is it used for?

It is used to treat rheumatoid arthritis, polyarticular juvenile idiopathic arthritis and psoriatic arthritis.

How is it taken?

It is given either as a monthly infusion (drip) in hospital or as a weekly injection under the skin which you can learn to do yourself.

Are there any side-effects?

The most common side-effects are caused by the infusion, and these are headaches, tiredness, feeling sick or vomiting, diarrhoea and dizziness. Abatacept can also make you more likely to develop infections.

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Why is abatacept prescribed?

You will be prescribed abatacept when you have tried methotrexate or another disease-modifying drug (DMARD) such as sulfasalazine or leflunomide. In Ireland, abatacept can be used either before or after other biologic therapies, such as the anti-TNF drugs and rituximab, but is almost always used in combination with methotrexate. Your rheumatologist will discuss the options with you.

Is there any reason I will not be prescribed abatacept?

Abatacept will not be prescribed if:

  • your rheumatoid arthritis is not active
  • you have not tried other disease-modifying drugs first
  • you are pregnant or breastfeeding
  • you have an active infection
  • you are currently taking an anti-TNF drug.

Your doctor may decide not to prescribe abatacept if:

  • you have had tuberculosis (TB) in the past
  • you have had repeated infections
  • you have had cancer.

When and how do I take abatacept?

Abatacept is only available on prescription from a consultant rheumatologist. It can be given by infusion (a drip into a vein) every month. This means that you will need to go to hospital or a clinic each month, where the drug will be given through a needle in your arm. This usually takes an hour or two.

Abatacept can also be given by a weekly injection under the skin (subcutaneous injection). Your local rheumatology unit will be able to advise if weekly injections are an option for you. The injections come in pre-filled single-dose syringes, and you, your partner or a carer can be shown how to give the injection. If you are already having abatacept by infusion and wish to switch to injections you should contact your rheumatology team for advice – you will probably start your injections when your next infusion is due.

How long does abatacept take to work?

If you respond to abatacept you will probably feel better in 2–12 weeks.

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What are the possible side effects?

Some side-effects can happen during or soon after the infusion or injection. The most common are dizziness and headaches, but these are not usually serious. Occasionally people can have an allergic reaction with sudden swelling, a rash or breathlessness. This is very rare, but if you do develop these symptoms, or any other severe symptoms, soon after a dose of abatacept you should seek medical advice immediately.

Abatacept has effects on the immune system (the body’s own defence system), and so you may be more likely to develop infections. The most common are chest and urinary infections. Importantly, because your immune system is suppressed, any symptoms of infection may also be milder. You should tell your doctor immediately if you develop any of the following after starting abatacept:

  • a sore throat
  • a fever
  • other symptoms of an infection
  • any new symptoms that concern you.

You should also tell your rheumatology team if you have any of these symptoms before having an infusion or injection. They may advise you to delay the treatment.

Chickenpox and shingles can be severe in people on treatments that affect the immune system such as abatacept. You may need antiviral treatment, which your doctor will be able to prescribe. Your abatacept will be stopped if you do develop chickenpox or shingles and restarted when you are better.

You should always read the patient information leaflet included with your medicines package to keep you informed about any possible side effects of your prescribed medications.

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What are the risks?

There may be a slightly increased risk of some cancers in patients using drugs like abatacept which interfere with the immune system. This is theoretically possible because the immune system is involved in recognising and killing cancerous cells. However, such a link has not been proven and is still being researched. Please discuss this with your doctor or rheumatologist if you are worried.

How can I reduce the risk of infection?

Because of its effects on the immune system, abatacept may make you more likely to pick up infections. You should try to avoid close contact with people with severe active infections, and visit and visit the Food Safety Authority of Ireland website www.fsai.ie for information on reducing your risk of infection from foods.

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Will it affect vaccinations?

If you are taking abatacept it is recommended that you avoid live vaccines such as yellow fever. However, in certain situations a live vaccine may be necessary (for example rubella vaccination in women of childbearing age), in which case your doctor will discuss the possible risks and benefits of the vaccination with you.

If you are in your 70s and are offered shingles vaccination (Zostavax) your doctor may advise you to have this before starting abatacept. Shingles vaccination is not recommended for people who are already on abatacept.

Pneumovax (which gives protection against the commonest cause of pneumonia) and yearly flu vaccines do not interact with abatacept and are recommended.

If you are unsure about having a vaccine you should discuss this with your doctor or health care professional.

Can I drink alcohol while on abatacept?

There is no known interaction between abatacept and alcohol. However, if you are also taking methotrexate, you should keep well within the recommended limits (1–2 units per day for women and 2–3 units per day for men) because methotrexate and alcohol can interact and damage your liver.

Does abatacept affect fertility or pregnancy?

If you are thinking of having a baby or if you become pregnant, you should discuss this with your rheumatologist. We do not yet know how abatacept might affect an unborn baby. Women of childbearing age therefore must use contraception while on abatacept. If you are planning to become pregnant, you should continue to use contraception for five months after stopping abatacept.

Men who are taking methotrexate along with abatacept should take contraceptive precautions for at least three months (and some doctors advise up to six months) after stopping treatment.

Does it affect breastfeeding?

Breastfeeding is not recommended if you are on abatacept. You should not restart your abatacept until you have stopped breastfeeding.

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What else should I know about abatacept?

It is recommended that you carry a biological therapy alert card, which you can get from your doctor or rheumatology nurse specialist. Then if you become unwell, anyone treating you will know that you are on abatacept and that you are therefore at risk of its side-effects.

Are there any alternatives?

A number of other drugs are used in the treatment of rheumatoid arthritis. Your doctor and rheumatology nurse specialist will discuss the other options with you.

Will I need any special checks while on abatacept?

You will probably have blood tests before treatment starts to assess your disease and the safety of taking the drug. You will also have a screening to check whether you have ever been exposed to tuberculosis (TB) or hepatitis. Some patients may need a course of treatment for latent (asymptomatic) TB before starting abatacept. If you are taking other drugs alongside your abatacept (such as methotrexate) you will need to continue your blood tests for these.

Abatacept may increase the risk of the hepatitis B infection being reactivated in people who carry the virus. If your doctor decides that you may be at risk from a previous hepatitis B infection, they may test your blood for the presence of hepatitis B.

Can I take other medicines alongside abatacept?

Usually you will already be taking methotrexate along with abatacept. However, you should always discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are on abatacept and methotrexate. You should also be aware of the following points:

  • Abatacept is not a painkiller. If you are already on a non-steroidal anti-inflammatory drug (NSAID) or painkillers you can carry on taking these as well as abatacept, unless your doctor advises otherwise. If abatacept works for you, you may be able to reduce your painkillers or NSAIDs after a time.
  • Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse specialist or pharmacist.

Can I continue with abatacept if I am going to have an operation?

Abatacept does not necessarily need to be stopped before an operation but you should discuss this with your doctor or rheumatology nurse specialist.

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