Abatacept

(Orencia®)

Orencia®

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Drug updated on 5/1/2024

Dosage FormInjection (intravenous; 250 mg Injection (subcutaneous; 50 mg/0.4 mL, 87.5 mg/0.7 mL, 125 mg/mL)
Drug ClassSelective T cell costimulation modulators
Ongoing and
Completed Studies
ClinicalTrials.gov

Indication

  • For the treatment of adult patients with moderately to severely active rheumatoid arthritis (RA).
  • For the treatment of patients 2 years of age and older with moderately to severely active polyarticular juvenile idiopathic arthritis (pJIA).
  • For the treatment of adult patients with active psoriatic arthritis (PsA).
  • For the prophylaxis of acute graft versus host disease (aGVHD), in combination with a calcineurin inhibitor and methotrexate, in adults and pediatric patients 2 years of age and older undergoing hematopoietic stem cell transplantation (HSCT) from a matched or 1 allele-mismatched unrelated donor.

Summary
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  • Abatacept (Orencia) is indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis, polyarticular juvenile idiopathic arthritis in patients 2 years and older, active psoriatic arthritis in adults, and as a prophylaxis for acute graft versus host disease in combination with other drugs.
  • A total of 23 studies were reviewed, providing information on abatacept's safety and efficacy compared to other Disease-Modifying Antirheumatic Drugs (DMARDs).
  • In treating Rheumatoid Arthritis (RA), abatacept has shown a similar decrease in glucocorticoid use as TNF-inhibitors and tocilizumab. However, withdrawal from glucocorticoids was slower than guidelines suggest.
  • For Juvenile Idiopathic Arthritis (JIA), study results indicate that abatacept provides a good balance between therapeutic success and the absence of serious adverse events. It shows particular promise in non-systemic JIA.
  • In cases of Psoriatic Arthritis, while TNF inhibitors are preferred over abatacept for preventing radiographic progression, abatacept has demonstrated effectiveness with an acceptable safety profile.
  • Subgroup comparisons suggest that abatacept might be more effective at early stages or in specific subgroups like those intolerant or non-responsive to TNFi treatments.
  • Tapering DMARDs including abatacept seems feasible but requires tailoring especially when achieving long-standing clinical remission.
  • The drug’s safety profile appears favorable across different DMARDs, particularly concerning serious infections and cardiovascular events, making it an important consideration during long-term therapy management.

Product Monograph / Prescribing Information

Document TitleYearSource
Orencia (abatacept) Prescribing Information.2023Bristol-Myers Squibb Company, Princeton, NJ

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Oral glucocorticoid use in patients with rheumatoid arthritis initiating TNF-inhibitors, tocilizumab or abatacept: Results from the international TOCERRA and PANABA observational collaborative studies.2024Joint Bone Spine
The Gap in Knowledge about Tapering Targeted Therapy being used as Monotherapy in Rheumatoid Arthritis: A Systematic Review.2024Current Rheumatology Reviews
Efficacy of non-conventional synthetic DMARDs for patients with rheumatoid arthritis-associated interstitial lung disease: A systematic review and meta-analysis.2023RMD Open
Analysis of efficacy and safety of abatacept for rheumatoid arthritis: Systematic review and meta-analysis.2023Clinical and Experimental Rheumatology
Changes of anti-citrullinated peptide antibodies titers after biologic treatment in patients with rheumatoid arthritis: A systematic literature review and retrospective study.2023Clinical and Experimental Rheumatology
Prevention of rheumatoid arthritis: A systematic literature review of preventive strategies in at-risk individuals.2023Autoimmunity Reviews
Biologic disease-modifying antirheumatic drugs for preventing radiographic progression in psoriatic arthritis: A systematic review and network meta-analysis.2023Pharmaceutics
Efficacy and safety of novel biologics in the treatment of lupus nephritis based on registered clinical trials: A systematic review and network meta-analysis.2023Clinical and Experimental Medicine
Safety of biological therapy in patients with rheumatoid arthritis in administrative health databases: A systematic review and meta-analysis.2022Frontiers in Pharmacology
Targeted systemic therapies for psoriatic arthritis: A systematic review and comparative synthesis of short-term articular, dermatological, enthesitis and dactylitis outcomes.2022RMD Open
Impact of using concomitant conventional DMARDs on adherence to biologic DMARD treatment in rheumatoid arthritis: Multi-centre, population-based cohort study.2021Seminars in Arthritis and Rheumatism
Model-based meta-analysis compares DAS28 rheumatoid arthritis treatment effects and suggests an expedited trial design for early clinical development.2021Clinical Pharmacology and Therapeutics
Most appropriate conventional disease-modifying antirheumatic drug to combine with different advanced therapies in rheumatoid arthritis: A systematic literature review with meta-analysis.2021Arthritis Care & Research
Reduction of biologics in rheumatoid arthritis: A systematic review and meta-analysis.2021Rheumatology International
The benefit-risk balance for biological agents in juvenile idiopathic arthritis: A meta-analysis of randomized clinical trials.2020Rheumatology
Comparative efficacy and safety of current therapies for early rheumatoid arthritis: A systematic literature review and network meta-analysis.2020Clinical and Experimental Rheumatology
Pharmacological treatment of psoriatic arthritis: A systematic literature research for the 2019 update of the EULAR recommendations for the management of psoriatic arthritis.2020Annals of Rheumatic Diseases
Safety of synthetic and biological DMARDs: A systematic literature review informing the 2019 update of the EULAR recommendations for the management of rheumatoid arthritis.2020Annals of Rheumatic Diseases
Efficacy of pharmacological treatment in rheumatoid arthritis: A systematic literature research informing the 2019 update of the EULAR recommendations for management of rheumatoid arthritis.2020Annals of Rheumatic Diseases
Prognostic factors of good response to DMARDs in psoriatic arthritis: A narrative review.2020Expert Review of Clinical Pharmacology
Biological DMARD efficacy in psoriatic arthritis: A systematic literature review and meta-analysis on articular, enthesitis, dactylitis, skin and functional outcomes.2020Clinical and Experimental Rheumatology
Presence of anti-cyclic citrullinated peptide antibodies is associated with better treatment response to abatacept but not to TNF inhibitors in patients with rheumatoid arthritis: A meta-analysis.2020Clinical and Experimental Rheumatology
Efficacy and safety of biologics in psoriatic arthritis: A systematic literature review and network meta-analysis.2020BMJ
The effect of non-TNF-targeted biologics on vascular dysfunction in rheumatoid arthritis: A systematic literature review.2019Autoimmunity Reviews
Comparison of adverse events of biologicals for treatment of juvenile idiopathic arthritis: A systematic review.2019Expert Opinion on Drug Safety
Comparative efficacy and safety of targeted DMARDs for active psoriatic arthritis during induction therapy: A systematic review and network meta-analysis.2019Seminars in Arthritis and Rheumatism

Clinical Practice Guidelines