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Orencia
abatacept
Adult Dosing .
Dosage forms: INJ (ClickJect auto-injector): 125 mg; INJ (pre-filled syringe): 125 mg per mL; INJ (vial): various
rheumatoid arthritis, moderate-severe
- [IV route, <60 kg]
- Dose: 500 mg IV q4wk; Start: 500 mg IV x1 on wk 0, 2, 4, then q4wk; Info: may transition from IV to SC dosing at next scheduled IV dose
- [IV route, 60-100 kg]
- Dose: 750 mg IV q4wk; Start: 750 mg IV x1 on wk 0, 2, 4, then q4wk; Info: may transition from IV to SC dosing at next scheduled IV dose
- [IV route, >100 kg]
- Dose: 1000 mg IV q4wk; Start: 1000 mg IV x1 on wk 0, 2, 4, then q4wk; Info: may transition from IV to SC dosing at next scheduled IV dose
- [SC route, <60 kg]
- Dose: 125 mg SC qwk; Info: may start 500 mg IV x1, then 125 mg SC x1 w/in 24h, then 125 mg SC qwk
- [SC route, 60-100 kg]
- Dose: 125 mg SC qwk; Info: may start 750 mg IV x1, then 125 mg SC x1 w/in 24h, then 125 mg SC qwk
- [SC route, >100 kg]
- Dose: 125 mg SC qwk; Info: may start 1000 mg IV x1, then 125 mg SC x1 w/in 24h, then 125 mg SC qwk
psoriatic arthritis
- [IV route, <60 kg]
- Dose: 500 mg IV q4wk; Start: 500 mg IV x1 on wk 0, 2, 4, then q4wk; Info: may transition from IV to SC dosing at next scheduled IV dose
- [IV route, 60-100 kg]
- Dose: 750 mg IV q4wk; Start: 750 mg IV x1 on wk 0, 2, 4, then q4wk; Info: may transition from IV to SC dosing at next scheduled IV dose
- [IV route, >100 kg]
- Dose: 1000 mg IV q4wk; Start: 1000 mg IV x1 on wk 0, 2, 4, then q4wk; Info: may transition from IV to SC dosing at next scheduled IV dose
- [SC route]
- Dose: 125 mg SC qwk
GVHD prophylaxis, acute
- [10 mg/kg/dose IV x1 on the day before transplantation (day -1), then 10 mg/kg/dose IV x1 on days 5, 14, 28 after transplantation]
- Max: 1000 mg/dose; Info: for patients undergoing HSCT from a matched or 1 allele-mismatched unrelated-donor; use w/ methotrexate and a calcineurin inhibitor; give EBV antiviral prophylaxis before tx and x6mo following HSCT; consider CMV antiviral prophylaxis during tx and x6mo following HSCT
COVID-19 (off-label)
- [10 mg/kg/dose IV x1]
- Max: 1000 mg/dose; Info: for hospitalized patients w/ severe COVID-19 requiring supplemental oxygen but not mechanical ventilation or extracorporeal membrane oxygenation (ECMO); not 1st-line agent
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ (ClickJect auto-injector): 125 mg; INJ (pre-filled syringe): 50 mg per 0.4 mL, 87.5 mg per 0.7 mL, 125 mg per mL; INJ (vial): various
polyarticular juvenile idiopathic arthritis, moderate-severe
- [IV route, 6-17 yo, <75 kg]
- Dose: 10 mg/kg/dose IV q4wk; Start: 10 mg/kg/dose IV x1 on wk 0, 2, 4, then q4wk
- [IV route, 6-17 yo, 75-100 kg]
- Dose: 750 mg IV q4wk; Start: 750 mg IV x1 on wk 0, 2, 4, then q4wk
- [IV route, 6-17 yo, >100 kg]
- Dose: 1000 mg IV q4wk; Start: 1000 mg IV x1 on wk 0, 2, 4, then q4wk; Max: 1000 mg/dose
- [SC route, 2-17 yo, 10-24 kg]
- Dose: 50 mg SC qwk
- [SC route, 2-17 yo, 25-49 kg]
- Dose: 87.5 mg SC qwk
- [SC route, 2-17 yo, >50 kg]
- Dose: 125 mg SC qwk
GVHD prophylaxis, acute
- [2-6 yo]
- Dose: 15 mg/kg/dose IV x1 on the day before transplantation (day -1), then 12 mg/kg/dose IV x1 on days 5, 14, 28 after transplantation; Info: for patients undergoing HSCT from a matched or 1 allele-mismatched unrelated-donor; use w/ methotrexate and a calcineurin inhibitor; give EBV antiviral prophylaxis before tx and x6mo following HSCT; consider CMV antiviral prophylaxis during tx and x6mo following HSCT
- [6 yo and older]
- Dose: 10 mg/kg/dose IV x1 on the day before transplantation (day -1), then 10 mg/kg/dose IV x1 on days 5, 14, 28 after transplantation; Max: 1000 mg/dose; Info: for patients undergoing HSCT from a matched or 1 allele-mismatched unrelated-donor; use w/ methotrexate and a calcineurin inhibitor; give EBV antiviral prophylaxis before tx and x6mo following HSCT; consider CMV antiviral prophylaxis during tx and x6mo following HSCT
psoriatic arthritis
- [2-17 yo, 10-24 kg]
- Dose: 50 mg SC qwk
- [2-17 yo, 25-49 kg]
- Dose: 87.5 mg SC qwk
- [2-17 yo, >50 kg]
- Dose: 125 mg SC qwk
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- infection, active
- caution: infection, chronic
- caution: infection, recurrent
- caution: TB infection, latent
- caution: HBV infection
- caution: HBV infection history
- caution: COPD
- caution: immunosuppressed patients
- caution: malignancy history
- caution: malignancy risk
- caution: elderly patients
Drug Interactions .
Overview
abatacept
T cell costimulation blocker
- immunomodulatory effects
Contraindicated
- adenovirus vaccine, live
- BCG live intravesical
- chikungunya vaccine, live
- cholera vaccine, live
- dengue vaccine, live
- influenza nasal vaccine, live
- measles/mumps/rubella vaccine, live
- rotavirus vaccine, live
- smallpox vaccine, live
- talimogene laherparepvec
- typhoid vaccine, live
- varicella vaccine, live
- yellow fever vaccine, live
Avoid/Use Alternative
- abrocitinib
- adalimumab
- anakinra
- anifrolumab
- baricitinib
- certolizumab pegol
- cladribine oral
- deuruxolitinib
- etanercept
- etrasimod
- golimumab
- infliximab
- natalizumab
- pimecrolimus topical
- rabies vaccine
- rilonacept
- ritlecitinib
- rituximab
- ruxolitinib topical
- sarilumab
- tocilizumab
- tofacitinib
- upadacitinib
Monitor/Modify Tx
- anthrax vaccine
- carfilzomib
- chikungunya vaccine
- COVID-19 vaccine
- diphtheria/tetanus vaccine
- diphtheria/tetanus/pertussis vaccine
- ebola vaccine, live
- everolimus
- Haemophilus b vaccine
- hepatitis A vaccine
- hepatitis B vaccine
- human papillomavirus vaccine
- influenza H5N1 vaccine
- influenza vaccine
- Japanese encephalitis vaccine
- meningococcal vaccine
- mitomycin
- pneumococcal vaccine
- poliovirus vaccine
- respiratory syncytial virus vaccine
- sipuleucel-T
- smallpox/mpox vaccine, live
- temsirolimus
- tick-borne encephalitis vaccine
- typhoid vaccine
Caution Advised
- abemaciclib
- acalabrutinib
- afamitresgene autoleucel
- aldesleukin
- alemtuzumab
- anti-thymocyte globulin
- atidarsagene autotemcel
- avacopan
- axicabtagene ciloleucel
- azacitidine
- azathioprine
- basiliximab
- beclomethasone inhaled
- beclomethasone nasal
- belatacept
- belimumab
- belinostat
- bendamustine
- betamethasone
- bimekizumab
- blinatumomab
- bortezomib
- brentuximab vedotin
- brexucabtagene autoleucel
- brodalumab
- budesonide
- budesonide inhaled
- budesonide nasal
- budesonide rectal
- busulfan
- cabazitaxel
- canakinumab
- carboplatin
- carmustine
- chlorambucil
- ciltacabtagene autoleucel
- cisplatin
- cladribine injection
- clobetasol ophthalmic
- clofarabine
- coccidioides immitis skin test antigen
- copanlisib
- corticotropin
- cortisone
- crovalimab
- cyclophosphamide
- cyclosporine
- cytarabine
- dactinomycin
- danicopan
- daratumumab
- daunorubicin
- decitabine
- deflazacort
- delgocitinib topical
- deucravacitinib
- dexamethasone
- dexamethasone ophthalmic
- difluprednate ophthalmic
- dimethyl fumarate
- dinutuximab
- diroximel fumarate
- docetaxel
- doxorubicin
- dupilumab
- duvelisib
- eculizumab
- efgartigimod alfa
- elivaldogene autotemcel
- elotuzumab
- elranatamab
- emapalumab
- epcoritamab
- epirubicin
- eribulin
- etoposide
- etuvetidigene autotemcel
- fingolimod
- floxuridine
- fludarabine
- fludrocortisone
- flunisolide nasal
- fluocinolone intravitreal
- fluorometholone ophthalmic
- fluorouracil
- fluticasone furoate
- fluticasone propionate
- fruquintinib
- gemtuzumab ozogamicin
- glofitamab
- guselkumab
- hydrocortisone
- hydrocortisone ophthalmic
- hydroxyurea
- ibritumomab tiuxetan
- ibrutinib
- idarubicin
- idecabtagene vicleucel
- idelalisib
- ifosfamide
- inebilizumab
- inotuzumab ozogamicin
- iptacopan
- irinotecan
- isatuximab
- ixabepilone
- ixekizumab
- lebrikizumab
- leflunomide
- lenalidomide
- lifileucel
- linvoseltamab
- lisocabtagene maraleucel
- lomustine
- loncastuximab tesirine
- loteprednol ophthalmic
- lymphocyte immune globulin, anti-thymocyte globulin
- melphalan
- mercaptopurine
- methotrexate
- methylprednisolone
- mirikizumab
- mitoxantrone
- mogamulizumab
- momelotinib
- mometasone implant
- mometasone inhaled
- mometasone nasal
- monomethyl fumarate
- mosunetuzumab
- mycophenolate mofetil
- mycophenolic acid
- nadofaragene firadenovec intravesical
- narsoplimab
- nelarabine
- nipocalimab
- obecabtagene autoleucel
- obinutuzumab
- ocrelizumab
- ofatumumab
- oxaliplatin
- ozanimod
- paclitaxel
- pegcetacoplan
- pentostatin
- pirtobrutinib
- polatuzumab vedotin
- pomalidomide
- ponatinib
- ponesimod
- pozelimab
- prednisolone
- prednisolone ophthalmic
- prednisone
- procarbazine
- quizartinib
- ravulizumab
- regorafenib
- rilzabrutinib
- risankizumab
- romidepsin
- ropeginterferon alfa-2b
- rozanolixizumab
- ruxolitinib
- satralizumab
- secukinumab
- selinexor
- sibeprenlimab
- siltuximab
- siponimod
- sirolimus
- sirolimus albumin-bound
- spesolimab
- sulfasalazine
- sutimlimab
- tacrolimus
- tafasitamab
- talquetamab
- tarlatamab
- teclistamab
- temozolomide
- teplizumab
- teriflunomide
- thioguanine
- thiotepa
- tildrakizumab
- tisagenlecleucel
- topotecan
- tralokinumab
- triamcinolone
- tuberculin purified protein derivative
- ublituximab
- ustekinumab
- vamorolone
- vedolizumab
- venetoclax
- vilobelimab
- vinblastine
- vincristine
- vinorelbine
- voclosporin
- zanubrutinib
- zilucoplan
Adverse Reactions .
Serious Reactions
- malignancy
- basal cell CA
- squamous cell CA
- infection, serious
- sepsis
- pneumonia
- cellulitis
- pyelonephritis, acute
- anaphylaxis
- angioedema
- hypersensitivity reaction, severe
- infusion reaction, severe
- multiple sclerosis
- vasculitis
- HBV reactivation
- EBV reactivation (acute GVHD prophylaxis use)
- CMV reactivation (acute GVHD prophylaxis use)
- acute kidney injury (acute GVHD prophylaxis use)
- post-transplant lymphoproliferative disorder (acute GVHD prophylaxis use)
Common Reactions
- headache
- URI
- nasopharyngitis
- nausea
- dizziness
- cough
- back pain
- HTN
- dyspepsia
- UTI
- diarrhea
- fever
- abdominal pain
- rash
- extremity pain
- infection, serious
- injection site reaction
- psoriasis, new or exacerbation
- pneumonia
- epistaxis
- hypermagnesemia
- anemia (acute GVHD prophylaxis use)
- CMV reactivation (acute GVHD prophylaxis use)
- CD4 count decr. (acute GVHD prophylaxis use)
- acute kidney injury (acute GVHD prophylaxis use)
- EBV reactivation (acute GVHD prophylaxis use)
Safety/Monitoring .
Monitoring Parameters
hepatitis B serology including HBsAg, TB test at baseline; dermatologic exams, especially if incr. skin CA risk; signs/symptoms of EBV, CMV reactivation during tx and x6mo post-transplant if acute GVHD prophylaxis use
Look/Sound-Alike Drug Names
Orencia confused with: Oracea
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; inadequate human data available; no known risk of teratogenicity based on animal data at 3x and 29x MRHD; for infants exposed to abatacept in utero, weigh risk/benefit before administering live vaccines
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available, though risk of infant harm not expected based on drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for abatacept: unknown; CYP450: unknown
Excretion: for abatacept: unknown; Half-life: 13.1-14.3 days
Subclass: DMARDs, T-cell Costimulation Modulators ; Immunosuppressants ; Psoriasis, Systemic Agents ; Spondyloarthropathies
Mechanism of Action
for abatacept: selectively modulates T-cell activation, altering immune response
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: Bristol-Myers Squibb Co.
DEA/FDA: Rx
Retail Price
Estimated prices only. For current pricing, visit GoodRx.
subcutaneous solution:
- 50 mg/0.4 mL (1 carton, 4 syringes): $12,378.00
- 87.5 mg/0.7 mL (1 carton, 4 syringes): $7,077.00
- 125 mg/mL (1 carton, 4 syringes): $4,957.00
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