ABATACEPT
| ABATACEPT (a-ba-ta ' sept) Orencia Classifications: biologic response modifier; fusion protein; disease-modifying antirheumatic drug (dmard); Therapeutic:antirheumatic (dmard); antiinflammatory Pregnancy Category: C |
Availability
250 mg lyophilized powder for injection
Action
Abatacept inhibits T-cell (T lymphocyte) proliferation and inhibits production of tumor necrosis factor (TNF)-alpha, interferon-gamma, and interleukin-2. It suppresses inflammation, decreases anticollagen antibody production, and reduces antigen-specific production of interferon-gamma.
Therapeutic Effect
Abatacept is used to reduce the number of activated T lymphocytes found in synovial fluid of rheumatoid arthritis patients. It relieves symptoms of rheumatoid arthritis and slows progression of structural damage. It improves physical function in adults with active rheumatoid arthritis who have had an inadequate response to other drugs.
Uses
Treatment of moderate to severe rheumatoid arthritis in patients with an inadequate response to one or more disease-modifying antirheumatic drugs (DMARDs). It may be used as monotherapy or in combination with other DMARDs, with the exception of TNF antagonists.
Contraindications
Known hypersensitivity to abatacept; live vaccines; active infections; co-administration with anakinra; pregnancy (category C); lactation.
Cautious Use
COPD, RA; malignancies.
Route & Dosage
| Rheumatoid Arthritis Adult: IV <60 kg, 500 mg; 60–100 kg, 750 mg; >100 kg, 1000 mg q2wk x 2, then q mo |
Administration
| Intravenous PREPARE: IV Infusion: Use the supplied silicone-free disposable syringe with an 18–21 gauge needle to reconstitute the vial. Add 10 mL sterile water to yield 25 mg/mL. To avoid foaming, gently swirl until completely dissolved. Do not shake or vigorously agitate. After dissolving, vent the vial with a needle to dissipate any foam. The reconstituted solution must be further diluted to a total of 100 mL as follows: from a 100 mL NS IV bag remove a volume equal to the total volume of abatacept in the reconstituted vials (e.g., for 2 vials, remove 20 mL). Using the supplied silicone-free syringe, slowly add the reconstituted abatacept to the IV bag and gently mix. The final concentration of the IV solution will be approximately 5, 7.5, or 10 mg/mL, depending on whether 2, 3, or 4 vials are used. Discard any unused abatacept. ADMINISTER: IV Infusion: Use a 0.2–1.2 micron low-protein-binding filter. Infuse over 30 min. INCOMPATIBILITIES Solution/additive: Should not be infused in the same intravenous line with other agents. Y-site: Should not be infused in the same intravenous line with other agents. |
- Store at 2°–8° C (36°– 46° F).
Adverse Effects (≥1%)
Body as a Whole: Infusion-related reactions, malignancies, cough, hypersensitivity reactions. CNS: Headache, dizziness. CV: Hypertension. GI: Nausea, dyspepsia. Musculoskeletal: Back pain, pain in extremity. Respiratory: Upper respiratory tract infection, nasopharyngitis, sinusitis, influenza, bronchitis. Skin: Rash. Urogenital: Urinary tract infection.Interactions
Drug: tnf antagonists increase the risk of serious infections.Pharmacokinetics
Half-Life: 13.1 d.Nursing Implications
Assessment & Drug Effects
- Prior to initiating treatment with abatacept, screen for latent TB infection with a TB skin test.
- Monitor for S&S of hypersensitivity (e.g., hypotension, urticaria, and dyspnea); discontinue infusion and notify physician if any of these occur.
- Monitor for S&S of infection. Withhold drug and notify physician if patient develops a serious infection.
- Monitor for deterioration of respiratory status in patients with COPD.
Patient & Family Education
- Report any of the following to a health care provider: any type of infection, a positive TB skin test, a recent vaccination, a persistent cough, unexplained weight loss, fever, sore throat, or night sweats.
- Report S&S of an allergic reaction that may develop within 24 h of receiving abatacept (e.g., hives swollen face, eyelids, lips, tongue, throat, or trouble breathing).
- Do not accept immunizations with live vaccines while taking or within 3 mo of discontinuing abatacept.
- Taking abatacept with TNF-blocker medications [etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade)] is not recommended.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug