Abatacept (Orencia)
Orencia (Abatacept) is a biologic medication used to treat rheumatoid arthritis, as well as some other types of arthritis.
Orencia is a synthetic protein that suppresses the body’s immune system. It prevents an important type of immune system cell, the T-cell, from turning on and becoming “activated”.
In patients whose arthritis is caused by their immune system attacking their own body’s tissues by mistake, Orencia helps to suppress the T-cell’s attack.
Methotrexate is commonly prescribed in combination with Orencia, which can improve a patient’s response.
Taking Orencia
Orencia is available as a weekly subcutaneous (under the skin) injection (Orencia SC) and a monthly intravenous infusion (Orencia IV).
The injection can be done quickly at home. The intravenous infusion is done in a specialized clinic.
The normal dose for the injection is 125 mg, once a week.
Watch our video to learn how inject Orencia at home:
Learn how to inject subcutaneous injectionsSubcutaneous injections (under the skin injections) are easy to do compared to other types of injections. A small needle pokes just under the skin to deliver medicine into the “fatty tissue” below.
The starting dose for intravenous infusions is 500 to 1000 mg, depending on body weight.
Patients receiving infusions are “ramped up” to a regular schedule when they get started. The first dose is administered at week 0. The second dose is given on week 2, and the third dose on week 4.
The “maintenance dose” begins 4 weeks after the third dose and infusions are then given every 4 weeks after that.
It can take about 30 to 60 minutes to receive an infusion at a clinic.
Orencia often takes 6 to 8 weeks before patients start feeling any effects. Some patients may notice benefit right after the first dose, and with others it can take several weeks. It can take 3 to 6 months to feel a lot of benefit.
The manufacturer of Orencia offers a support program to Canadian patients that are prescribed the medication:
Patient support program enrolment formsImportant Tests and Risks
Orencia can make it a bit harder for people to fight off infections.
Patients taking this medicine should call their doctor they have a fever, think they have an infection, or have been prescribed antibiotics to treat an infection.
Patients should coordinate with their doctor to stop treatment before any surgery. It can be re-started once things have healed and there’s no sign of infection.
Patients should discuss all vaccinations with their doctor because some (live vaccines) are not advisable to get while taking Orencia.
It is important to get a TB (tuberculosis) skin test and a chest x-ray before starting Orencia.
Orencia is a newer medication so there is no reliable information about its safety in patients who are pregnant or breastfeeding.
It is recommended to avoid pregnancy or breastfeeding while taking this medication.
Science
In some people with inflammatory arthritis, the body’s immune system becomes confused. It mistakes the cells of the body’s own joints for foreign invaders and attacks them. When the body’s immune system attacks normal body cells by mistake, it is called an autoimmune disease.
Orencia is a synthetic protein called a fusion protein that is a type of modified antibody. It was created by researchers to suppress the body’s immune system.
Orencia works by preventing an important immune system cell, the T-cell, from becoming activated, or turned on. In patients whose T-cells are attacking the body’s own joints by mistake, this effect helps reduce the attack.
Patients can benefit from reduced pain and swelling (inflammation) in the joints, improved day-to-day function, and the prevention of long-term damage.
The immune system is an important system in the body that fights off attacks from dangerous invaders like bacteria and viruses that make people sick.
Because Orencia suppresses the immune system, patients taking the medication will have a slightly harder time fighting off infections. At the same time, Orencia can help to stabilize overactive immune systems in patients whose T-cells are attacking bodily tissues that they shouldn’t.
Safety
Orencia’s (abatacept’s) ability to suppress the immune system can make it harder for patients to fight infections. It is important for patients to tell their doctor if they have a fever or infection, or if they think they might have an infection.
MORE COMMON side-effects include:
- Nausea & diarrhea
- Back pain
- Rash, flushing
- Headaches or dizziness
- Upper respiratory tract infections (such as sinusitis). Patients who have an infection should contact their doctor.
RARE side-effects include:
- Injection Site Reaction: Redness, swelling, and discomfort around the area injected
- Infection: Any infections or fevers should be taken seriously and reviewed by a doctor.
- Lungs: Orencia may worsen symptoms of COPD (emphysema) and pneumonia
- Malignancy: Orencia may be associated with a small increased risk of developing certain types of cancer.
How to minimize the side-effects of Orencia (abatacept):
- All patients should have a TB (tuberculosis) skin test and a chest x-ray before starting Orencia
- Take Orencia as prescribed by a doctor.
Patients should talk to their doctor if they are concerned about any side effects.
Orencia can simply be stopped. It does not need to be “weaned off” like some other medications. However, a patients’ arthritis will likely “flare” for a few weeks after stopping. Patients should talk to their doctor if they want to stop taking this medication.
People who should NOT be taking Orencia (abatacept) include:
- Patients who have had a previous serious allergic reaction to Orencia
- Women who are pregnant, planning on becoming pregnant, or are breast feeding
- Patients who have cancer, or have had a past history of certain types of cancers
- Patients with active infections (such as tuberculosis)
- Patients who are about to have surgery should consult their doctor about when to stop/start Orencia.
Anyone who becomes pregnant while taking Orencia should notify their doctor.
It is unknown if Orencia is safe in pregnancy or breastfeeding. Therefore, it is best to avoid pregnancy while on this medication. All women of child bearing potential who are taking Orencia should use reliable contraception.
Patients taking Orencia (Abatacept) should call their doctor if they feel sick and want to stop, or if they are concerned about any side effects.
Other reasons to call a doctor while taking Orencia include:
- Fever
- Infection: Patients with an infection (or think they have an infection), or if they have been prescribed antibiotics should call their doctor
- Severe injection site reaction
- Rash: Patients who develop a bad rash
- Surgery: Orencia should be stopped before surgery. It can be restarted once things have healed and there is no sign of infection. Patients having surgery should talk to their doctor about when to stop the medicine.
- Vaccinations: Patients should discuss all vaccinations with their doctor because some vaccines are not advisable while taking Orencia.
- Emphysema (COPD) and Pneumonia: Orencia can worsen symptoms of emphysema (COPD) and make pneumonia worse. Patients who have emphysema or COPD should tell their doctor.
- History of Cancer: Orencia has very rarely been associated with developing certain types of cancer. Patients who have had cancer in their past should make sure their doctor knows.
Video
Watch Dr. Andy Thompson, a Canadian rheumatologist, introduce Orencia in this short video:
Resources
DIN
- 02282097 (IV)
- 02402475 (SC)