Treating Rheumatoid Arthritis With Orencia (Abatacept)

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Orencia (abatacept) is a biologic drug approved for the treatment of moderate to severe rheumatoid arthritis. It is also used to treat psoriatic arthritis and moderate to severe juvenile idiopathic arthritis.

Orencia is not a TNF blocker like Enbrel (etanercept ) or Humira (adalimumab) in which an inflammatory protein called tumor necrosis factor (TNF) is suppressed. Instead, Orencia works by blocking the chemical signals that trigger the autoimmune assault.

Treatment is available in two formulations:

  • Orencia can be delivered in a 30-minute intravenous (IV) infusion every four weeks after an initial loading dose (first dose, the second dose at two weeks, and doses every four weeks thereafter).
  • Orencia is also available in a subcutaneous formulation which allows people to give themselves a shot in either the thigh, abdomen or upper arm. Treatment often begins with an IV loading dose followed by a subcutaneous shot a day later. The injections are then self-administered weekly.

While Orencia is able to slow joint damage and reduce arthritic pain, it is important to understand how the drug works, when it is prescribed, and what, if any, risks are associated with use. Here are five facts that may help:

1. Orencia Is Typically Prescribed After Other Treatments Have Failed

Orencia is often used in people with moderate to severe rheumatoid arthritis who have not responded to one or more disease-modifying antirheumatic drugs (DMARDs) such as methotrexate or other biologics such as Enbrel or Humira.

Abatacept may be used alone or in combination with DMARDs, which makes it more potent, but not with other biologic drugs. Orencia can be considered for first-line therapy in persons with early active rheumatoid arthritis.

2. Orencia Works by Suppressing the Immune System

The biologic drugs used to treat rheumatoid arthritis aim to prevent the immune system from attacking its own tissue, specifically those of the joint.

To do this, the drugs need to shut down facets of the immune response. In doing so, it leaves the body open to infections it could otherwise fight. The most common of these include respiratory tract infections (including pneumonia), septic arthritis, skin and soft tissue infections, and urinary tract infections.

However, a number of studies have shown that Orencia is associated with a far lower risk of serious infection and hospitalization when compared to Enbrel, Rituxan (rituximab), and Actemra (tocilizumab).

3. People on Orencia Are at an Increased Risk of Tuberculosis

Chief among the concerns is the risk of tuberculosis (TB), primarily the reactivation of the TB in persons previously infected. Research suggests that persons exposed to Orencia have as much as a four-fold increase in the risk of such reactivation.

Before starting treatment, people must be screened for TB. Persons with an active TB infection must be successfully treated before any biologic drug can be used.

4. People on Orencia Need to Avoid Live Vaccines While on Treatment

Live attenuated vaccines are those that contain live, weakened viruses (as opposed to inactivated vaccines which used "killed" viruses).

Because Orencia weakens a person's immune defenses, there is a chance that a live vaccine can cause the very disease it aims to prevent. As such, people on Orencia are advised to avoid live vaccines before the start of treatment, during treatment, and for three months following completion of treatment. These include:

  • Nasal influenza spray (FluMist)
  • Shingles vaccine
  • Varicella (chickenpox) vaccine
  • Measles-mumps-rubella (MMR) vaccine
  • Rotavirus vaccine
  • Yellow fever vaccine
  • Typhoid

5. Orencia Should be Used With Caution in People With COPD

In clinical trials, people with chronic obstructive pulmonary disease (COPD) experienced a higher rate of COPD exacerbations while on Orencia, including a persistent cough, shortness of breath, and wheezing.

For this reason, Orencia should be used with caution in people with COPD, weighing the benefits against the possible consequences. Moreover, greater care should be given to monitoring individuals with COPD in the event respiratory symptoms worsen. In such case, treatment may need to be stopped.

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Article Sources

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  • De Keyser, F. "Choice of Biologic Therapy for Patients with Rheumatoid Arthritis: The Infection Perspective." Curr Rheumatol Rev. 2011; 7(1):77–87. DOI: 10.2174/157339711794474620.
  • Yun, F.; Xie, F.; Delzell, E. et al. "Comparative Risk of Hospitalized Infection Associated With Biologic Agents in Rheumatoid Arthritis Patients Enrolled in Medicare." Arthritis & Rheumatology. 2015; 68:56-66. DOI: 10.1002/art.39399.