Abatacept

 

What is Abatacept?

Abatacept is a targeted disease modifying anti-rheumatic drug (DMARD) that is used to reduce inflammation produced by the body. In certain diseases the immune system is over active, this can target healthy tissues such as joints. Abatacept works on the inflammatory pathway to reduce the effects of cells called T cells, thereby reducing the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints.

 

What is Abatacept used for?

Abatacept is used for the treatments of inflammatory diseases such as:

• Rheumatoid arthritis
• Psoriatic arthritis

 

How is it taken?

Abatacept can be taken in 2 ways and can be given alongside other DMARDs such as methotrexate, or taken on its own.

 

Subcutaneous injection

It can be taken as an injection into the layer of fat between the skin and muscle. This is called a subcutaneous injection and is usually given into the thigh or abdomen. It is given at a dose of 125mg once a week.

The injection device is available as a pen or prefilled syringe. It should be stored in the fridge at home.

 

Infusion

It can also be given as an injection into the vein through a drip. This is called an intravenous infusion and is usually given in the rheumatology day unit. You will be monitored throughout and for 1-2 hours after this to make sure you have not developed and side effects.

Medications to prevent a reaction to the drip are given at the same time; these include steroids, paracetamol and anti-histamine.

The dose is calculated from your weight and it is given as a loading treatment initially, with infusions at 0, 2 and 4 weeks, it is then given every 4 weeks whilst you remain on the medication.

 

The medication can take up to 12 weeks to have an effect. When you first start taking it you will need your bloods monitored. This is done every 3 months if you are receiving the infusions and at 3 months and then annually if you are receiving the subcutaneous injections. However if you are also on another medication such as methotrexate, you will need to continue your blood monitoring for this.

 

If you symptoms are well controlled, your doses can be gradually reduced.

 

 

Side effects

There are a few possible side effects that can occur in a small number of people that take abatacept, these include:

 

• Feeling sick, vomiting and headaches
  • These usually settle after taking the medication for a few weeks.
• Increased risk of infections
  • As abatacept dampens the immune system, you can be more prone to infection. You should be seen by your GP if you feel unwell in case you need antibiotics. You must temporarily stop your injections/ infusions whilst you are unwell and receiving treatment, they can be started up again when you feel well.
  • You should try to avoid contact with others that have chicken pox or shingles.
• Subcutaneous injection site reactions
  • Irritation, rashes and blistering can occur.
  • Mild steroid creams and antihistamines can be used to settle things down. If these don’t work, then you should see your GP.
• Infusion reactions
  • Sometimes people can have a reaction whilst receiving the drip, this is reduced by the pre medications that are given. Your observations including blood pressure and pulse are regularly checked.
  • If you have a severe reaction, no further abatacept will be given.
• There is no evidence currently that suggests an increased risk of developing cancer with abatacept, however long term studies are on going.
• Progressive Multifocal Leukoencephalopathy (PML)
  • This is a very rare side effect where activation of a virus when triggered can affect the brain and spinal cord. There have been no cases reported with abatacept use, but this side effect may be associated with related drugs.

 

Cautions of use

Interactions with other medications

• Your doctor will check if there are any medications that could interact.
• You can carry on taking your usual painkillers including NSAIDs.

Contraindications of other conditions

• Before starting any biological therapy, your bloods will be checked for infections that can become active again when the immune system is suppressed, this includes hepatitis B, C and HIV. A blood and chest X-ray is taken to exclude previous TB exposure. If you are found to have had previous TB exposure you may need to start preventative antibiotics for a short period before the abatacept is commenced.
• If you have severe heart conditions, abatacept may not be suitable.

Operations

• Abatacept should be withheld for 1 week after the last dose would have been due. For example:
  • If you are on subcutaneous injections every 2 weeks, surgery can occur in week 3.
  • If you are on infusions every 4 weeks, you can have surgery from week 5.

During pregnancy and breastfeeding

• There is currently no data on abatacept in pregnancy or breastfeeding. Therefore it should not be used.
• If you are considering starting a family, abatacept should be stopped at least 14 weeks before trying to conceive.
• There is no data on the use in males who are trying to conceive.

Alcohol

• Alcohol and abatacept do not interact, however it is recommended to take alcohol within moderation, following the guidelines of less than 14 units weekly.

Vaccinations

• Flu and the pneumonia vaccine are safe and recommended whilst taking abatacept.
• Live vaccines including the shingles vaccine should not be given due to the dampening down of the immune system.

 

Useful Links

Versus Arthritis: http://www.versusarthritis.org