Adult Dosing
Rheumatoid Arthritis
Intravenous dosing
- <60 kg: 500 mg IV; subsequent doses at 2 wk, 4 wk after the first infusion and then q4 wks thereafter
- 60-100 kg: 750 mg IV; subsequent doses at 2 wk, 4 wk after the first infusion and then q4 wks thereafter
- >100 kg: 1000 mg IV; subsequent doses at 2 wk, 4 wk after the first infusion and then q4 wks thereafter
Note:
- Administer each dose over 30 minutes
- May be used as monotherapy or in combination with DMARDs except TNF antagonists
Subcutaneous dosing
- 60 kg: 500 mg IV; followed by 125 mg SC within 24 hr and 125 mg SC qwk therafter
- 60-100 kg: 750 mg IV; followed by 125 mg SC within 24 hr and 125 mg SC qwk therafter
- >100 kg: 1000 mg IV; followed by 125 mg SC within 24 hr and 125 mg SC qwk therafter
Note:
- Patients unable to receive infusion may start with SC dosing without an IV loading dose
- Patients transitioning from IV to SC should administer SC dose initially instead of next scheduled IV dose
Pediatric Dosing
- Safety and effectiveness in pediatric patients <6 years of age have not been established
Juvenile idiopathic arthritis
- <75 kgs:10 mg/kg IV, subsequent doses at 2 wk, 4 wk after the first infusion and then q4 wk thereafter
75 kg-100 kg: 750 mg IV; subsequent doses at 2 wk, 4 wk after the first infusion and then q4 wk thereafter- >100 kg: 1000 mg IV; subsequent doses at 2 wk, 4 wk after the first infusion and then q4 wk thereafter
- Max: 1000 mg
Note: Administer each dose over 30 minutes
- Concurrent therapy of abatacept and TNF antagonist is not recommended because it increases the risk of serious infections. Monitor patients for signs of infection when transitioning the therapy from TNF antagonist to abatacept therapy
- Hypersensitivity reaction such as hypotension, urticaria, and dyspnea have been associated with the therapy, appropriate medical support should be available for treatment of such hypersensitivity reaction
- Caution should be exercised in patients with a history of recurrent infections, chronic, latent, or localized infections, underlying conditions which may predispose them to infections. Closely monitor patient who develops a new infection and discontinue the drug if a serious infection develops
- Screen all patients for latent tuberculosis infection with a tuberculin skin test prior to initiating immunomodulatory therapies. Patient with positive test should be treated with standard therapy prior to initiating abatacept
- Reactivation of hepatitis B has been associated with antirheumatic therapies. Screen for viral hepatitis before starting abatacept
- Live vaccines should not be given concurrently or within 3 months of discontinuation of abatacept therapy
- Use cautiously in adult COPD patients as abatacept has been associated with COPD exacerbations, cough, rhonchi, and dyspnea. Monitor the patients for worsening of their respiratory status
- Patient should be brought up to date with all immunizations prior to initiating the therapy
- May reduce T cell mediated host defenses against infections and malignancies
Cautions: Use cautiously in
- Chronic Obstructive Pulmonary Disease (COPD)
- Latent tuberculosis
- Hepatitis B
- Elderly patients
- Hypersensitivity
- History of recurrent infections
Pregnancy Category:C
Breastfeeding: Safety unknown; because of the potential for possible serious adverse reactions in nursing infants a decision should be made to discontinue breastfeeding, or to discontinue the drug (taking into account the importance of the drug to the mother).
