bDMARDs Quick Reference Guide

Abatacept (IV)

Abatacept (IV)

Active ingredient

Abatacept

Mechanism of action

T cell co-stimulation modulator

Molecule type

Fusion protein

PBS listed indications

Severe active rheumatoid arthritis

Reference product (brand)

Orencia IV

Biosimilar brands

None

Administration information

Mode of administration

IV infusion

Administration devices and strengths

Vial for IV infusion (250mg lyophilised powder)

Frequency of administration

Loading - refer to timing of initial IV doses in standard dosing information
Maintenance - every 4 weeks

Storage

Store at 2-8oC (refrigerate do not freeze).
Keep vials in the outer carton until time of use to protect from light.
Do not shake during reconstitution.

Standard dosing

IV administration utilises weight-range based dosing.

Initial administration followed by doses at weeks 2 and 4 after first infusion then every 4 weeks.

Pt. body weightDose
<60kg500mg
60-100kg750mg
>100kg1g

IV infusion is given over 30 minutes.

Treatment with csDMARDs (e.g. methotrexate) may be continued during treatment with abatacept.

Dose variations

Patients with rheumatoid arthritis who are in remission or have low disease activity may have their dose of abatacept down-titrated by their rheumatologist

  • 10mg/kg infusion per month reducing to 5mg/kg infusion per month

Special notes

Monitor for anaphylaxis and infusion reactions during and after the infusion. Infusion reactions including dizziness, nausea, flushing and hypotension can occur within one hour of infusion and up to 24 hours after infusion.

 

The use of abatacept in combination with other cytokine modulators (e.g. TNF-alpha inhibitors, rituximab, anakinra, tocilizumab) is not recommended due to increased risk of infection.

 

Abatacept is contraindicated in serious or untreated infection, e.g. sepsis, abscess, hepatitis B, active TB (before completing TB treatment).
May reactivate inactive hepatitis B and latent TB (begin TB treatment before starting abatacept).
Patients with suspected latent or active TB should be treated in consultation with an Infectious Diseases physician.

 

Live vaccines should not be given concurrently with abatacept or within 3 months of discontinuation.

References

Pharmaceutical benefits Scheme (PBS) listing. Available from https://www.pbs.gov.au/medicine/item/5605B-9621J [accessed 6/10/21]

Product information. Available from https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-03513-3 [accessed 6/10/21]

Australian Medicines Handbook 2020 (online). Adelaide: Australian Medicines Handbook Pty Ltd; 2020 July. Available from: https://amhonline.amh.net.au/  [accessed 3/5/21]

NPS Medicinewise. Down-titration strategies. Available from https://www.nps.org.au/bdmards/rheumatology-conditions/titration-strategies  [accessed 3/5/21]