Abatacept

Abatacept 

Orencia

Classification

Biologic and immunological; Immunomodulator; Disease-modifying antirheumatic drug (DRMARD)

Therapeutic action

Antirheumatic (DMARD); Anti-inflammatory

Pregnancy category

C

Action and Therapeutic Effects

Abatacept inhibits proliferation of T-lymphocytes and also inhibits production of tumor necrosis factor (TNF)-alpha, interferon-gamma, and interleukin-1 (IL-2, IL-6, and IL-15). Thus it suppresses inflammation, decreases anticollagen antibody production, and reduces antigen-specific production of interferon-gamma.

As a result of treatment a reduced number of activated T lymphocytes is  found in synovial fluid of the patients. Drug relieves RA symptoms and slows progression of structural damage of joints. It helps to improve physical function in adults and is used to treat the patients with active RA who already have had an inadequate response to other treatment options.

Uses, Indications

Abatacept is used for the treatment of moderate to severe rheumatoid arthritis or juvenile rheumatoid arthritis.

Contraindications
  • Known hypersensitivity to abatacept
  • Abatacept should not be prescribed if live vaccines are used
  • Drug is contraindicated in active infections
  • This drug should not be coadministrated with anakinra, TNF antagonists,  and other biologic therapy for Rheumatoid arthritis.
  • Lactating mothers should not use Abatacept.
Use cautiously
  • If patient suffers from  COPD
  • If malignancies found
  • In pregnancy ( drug belongs to category C)
  • If you treat children younger than 6 years
Side effects
  • General complications: Infusion-related reactions malignancies, cough, hypersensitivity reactions.
  • CNS complications: Headache, dizziness.
    CV complications : Hypertension.
  • GI complications: Nausea, dyspepsia.
  • Musculoskeletal complications: Back pain, pain in extremity.
  • Respiratory complications: Upper respiratory tract infection, nasopharyngitis, sinusitis, influenza,
    bronchitis.
  • Skin complications: Rash.
  • Urogenitalcomplications: Urinary tract infection
Administration

 

Subcutaneous administration

Abatacept for subcutaneous injection is supplied in a 125mg/mL prefilled syringe.
The small bubbleof air in the syringe should nto be removed. You should not pull back on the plunger head before
injection.
The full contents of the syringe should be injected.

Injection sites must be rotated.
Storage:  Prefilled syringes must be stored between 2°–8° C (36°–46° F). Do not freeze.

The prefilled syringe is for subcutaneous injection only. Do not use the prefilled syringe  for IV infusion.

IV Infusion:

  • For IV infusion  a 0.2–1.2 micron low-protein-binding filter should be used.
  • Infuse  the drug over 30 min.
  • Abatacept 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.
Pharmacokinetics

Half-Life of the drug is 13.1 days

Interactions

Concomitant use of this drug with TNF antagonistsincrease the risk of serious infections. Avoid concomitant use of anakinra.

Nursing implications

Prior to initiating treatment with abatacept, patient should be screened for latent TB infection with a TB skin test.

Monitor
  • During IV administration, patient should be monitored for signs and symptoms of hypersensitivity, including hypotension, urticaria, and dyspnea. In case of hypersensitivity infusion should be discontinued and prescriber should be notified.
  • Patient should be monitored for signs and symptoms of infection. If a patient develops a serious infection, the drug should be witheld and prescriber notified.
  • Respiratory status of the patient should be monitored during the treatment in patients with COPD.
Patient and Family education

Health provider should be alerted in the case of : any type of infection, or a positive TB skin test, or a recent vaccination, or a persistent cough, or unexplained weight loss, fever, sore throat, or night sweats.

Signs and symptoms of an allergic reaction may develop within 24 h of receiving abatacept. Including  hives
swollen face, eyelids, lips, tongue, throat, or difficulty breathing. They must be reported to the health provider.

While taking abatacept or within 3 months of discontinuing the drug, immunizations with live vaccines are not permitted and should not be accepted.

 

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