Orencia Abatacept

Abatacept, trade name Orencia, is a biologic medication for rheumatoid arthritis. Ads for it have been on tv.  It reduces the inflammation that causes some of the symptoms of RA. It is also used for adult psoriatic arthritis and juvenile idiopathic arthritis.

Response to expect                                                                                                                According to clinical trials of Orencia use, up to 75% of patients had a 20% improvement at six months. About 50% had up to a 50% improvement. About 13% had a 75% improvement. In these studies, methotrexate was also being given.

Pill, shot or IV?                                                                                                                        Abatacept is a large molecule which means that it would not be absorbed into the body if taken by mouth. It is administered by injection under the skin subcutaneously. It is a similar process that a diabetic uses when administering insulin in a syringe. Abatacept comes in a prefilled syringe and it also comes in a Clickjet which is an autoinjector. It must be kept away from the light and stored under refrigeration until 30-45 minutes before use. It is also administered intravenously(IV) in a medical facility. Both methods are effective.

In preparation                                                                                                                          A TB test is required. Tests for hepatitis B are also given. It is recommended that the newer shingles vaccine, Shingrix, be given. It is given in two doses over two to six months apart. It is not live so may be given before or during Abatacept use. A flu vaccine is also recommended which is also not live.

Pregnancy and lactation                                                                                                                   

Effects of Orencia on the fetus during pregnancy and in breast milk are unknown.

Common side effects                                                                                                            The most common side effects of Abatacept are upper respiratory infections, such as common cold and sinus infection, sore throat and also headache and nausea.

Black box warning                                                                                                                  There is no black box warning for Abatacept.

Serious side effects                                                                                                                    Infection is potentially a serious and common complication of the biologic medications. The biologic medications depresses the immune system. Abatacept is no exception. The most common serious infections involving Abatacept are pneumonia and sepsis. The following is a quote from the Abatacept drug insert: “Some of these infections have been fatal”. Severe allergic reaction has occurred. Hepatitis B virus reactivation is a possibility. Before starting on Abatacept, a person should be given tests for the hepatitis B virus. COPD patients on Abatacept have more adverse events than those without COPD.

Cost                                                                                                                                         Four prefilled syringe of 125 mg of Abatacept without coverage would cost about $4500.00 a month in 2019 according to goodrx.com and wellrx.com. It is similar in cost to Actemra. It is hard to assess insurance copays as they are different in the various insurance plans. There can be no generic drug for Abatacept. The drug is made from a live cell not a chemical formula that can be duplicated. There is not a biosimilar for Abatacept. A biosimilar is a drug that is made in a similar but not exact same way as the original. There are a few RA biologics that have biosimilars. The difference in cost is not huge.

History                                                                                                                                        Abatacept was developed by the American pharmaceutical Bristol-Myers Squibb. It was FDA approved in 2005 for RA.

Action                                                                                                                                          Orencia is a selective co-stimulation modulator. Orencia works by inhibiting the action of the T cells. It interferes with the early stage of the inflammation process reducing inflammation.

Our immune system has many components. Various biologic drugs have been designed to affect individual overactive factors in our immune systems. Actemra affects IL-6.  Humira and Embrel affect TNF (tumor necrosis factor). Orencia affects T cells. Rituxan affects B cells. Each are designed to suppress a particular overactive molecule in our immune system.

Do not be discouraged if one immunosuppressive drug doesn’t work for you. Try another.  It might work better. There doesn’t seem to be a test to determine which molecules in the immune system are causing an individual’s RA or which biologic will work best.

Read the drug package insert.                                                                                            Informative. The difficulty of it is thin paper and a small font. The information is helpful.

Visit the Orencia website.                                                                                              It is full of information. Also read the section intended for medical people as well.

RA biologics are magic bullets for many of us. But they come with serious cautions. It is a smart person who checks out the cautions and determines two things. First, she needs to determine what is her individual risk and what she will need to do to protect herself. Second, she needs to weigh her need for relief with the cost of the biologic and with the possible complications. Doctors recommend, but we need to determine what is the right choice for us.