Nurses Compass
Drug Guide
Abatacept
Classification
Therapeutic: Immunomodulator, Disease-modifying Antirheumatic Drug (DMARD)
Pharmacological: Fusion protein that inhibits T-cell activation
FDA Approved Indications
- Moderate to severe rheumatoid arthritis in adults
- Juvenile idiopathic arthritis in pediatric patients
Mechanism of Action
Abatacept is a fusion protein that inhibits T-cell activation by binding to CD80 and CD86 on antigen-presenting cells, preventing costimulatory signal required for full T-cell activation, thereby reducing inflammation.
Dosage and Administration
Adult: Typically 500 mg intravenously on days 1, 15, and 29, then every 4 weeks. Dose may be adjusted based on clinical response.
Pediatric: Dosing based on weight; usually 10 mg/kg IV on days 1, 15, and 29, then every 4 weeks; adjusted according to response.
Geriatric: No specific reduction in dose, but caution advised due to comorbidities.
Renal Impairment: No dose adjustment necessary.
Hepatic Impairment: No specific dosing recommendations available.
Pharmacokinetics
Absorption: Administered IV; absorption not applicable.
Distribution: Distributed mainly in plasma and extracellular fluid.
Metabolism: Metabolized via proteolytic enzymes; not CYP450-dependent.
Excretion: Excreted mainly as peptides; not primarily through renal or hepatic routes.
Half Life: 13-16 days.
Contraindications
- Severe active infections
- Known hypersensitivity to Abatacept or its components
Precautions
- Patients with previous serious infections or history of recurrent infections
- Screen for TB before initiation
- Use with caution in patients with immunosuppression
- Monitor for infections during therapy
- Avoid live vaccines during treatment
Adverse Reactions - Common
- Headache (Common)
- Upper respiratory tract infection (Common)
- Nasopharyngitis (Common)
Adverse Reactions - Serious
- Serious infections (e.g., pneumonia, sepsis) (Uncommon)
- Hypersensitivity reactions including anaphylaxis (Rare)
- Progressive multifocal leukoencephalopathy (PML) (Extremely rare)
Drug-Drug Interactions
- Other immunosuppressants, live vaccines likely to increase risk of infections
Drug-Food Interactions
- No significant interactions reported
Drug-Herb Interactions
- No well-established interactions
Nursing Implications
Assessment: Monitor for signs of infection, vaccination history, hepatic function, and TB status.
Diagnoses:
- Risk for infection
- Impaired skin integrity
Implementation: Administer IV as prescribed, monitor infusion reactions, educate about infection risks, ensure TB screening and vaccination status are up to date.
Evaluation: Assess effectiveness in reducing disease activity, monitor for adverse effects, infection control.
Patient/Family Teaching
- Report signs of infection immediately.
- Avoid live vaccines during therapy.
- Maintain good hygiene and infection prevention practices.
- Understand the importance of regular blood tests and medical follow-up.
Special Considerations
Black Box Warnings:
- Serious infections and malignancies
Genetic Factors: Data insufficient to determine genetic risk factors.
Lab Test Interference: May affect immune response markers; interpret with caution.
Overdose Management
Signs/Symptoms: Unknown, but could include heightened immunosuppression or unexpected adverse reactions.
Treatment: Supportive care; no specific antidote.
Storage and Handling
Storage: Store vials refrigerated (2-8°C); do not freeze.
Stability: Stable until expiration date when stored properly.