Abatacept

Abatacept (marketed as Orencia) is a drug used to treat autoimmune diseases like rheumatoid arthritis, by interfering with the immune activity of T cells. It is a modified antibody. Abatacept (marketed as Orencia) is a drug used to treat autoimmune diseases like rheumatoid arthritis, by interfering with the immune activity of T cells. It is a modified antibody. Abatacept is a fusion protein composed of the Fc region of the immunoglobulin IgG1 fused to the extracellular domain of CTLA-4. In order for a T cell to be activated and produce an immune response, an antigen presenting cell must present two signals to the T cell. One of those signals is the major histocompatibility complex (MHC), combined with the antigen, and the other signal is the CD80 or CD86 molecule (also known as B7-1 and B7-2). Abatacept binds to the CD80 and CD86 molecule, and prevents the second signal. Without the second signal, the T cell can't be activated. Abatacept was developed by Bristol-Myers Squibb and is licensed in the United States for the treatment of rheumatoid arthritis in the case of inadequate response to anti-TNFα therapy. Some doctors criticize its cost ($3,500 to $3,800 a month, like other biological drugs of its class) and its promotional marketing. Abatacept is used to treat adults with moderate to severe rheumatoid arthritis (RA) as a second line agent, and as a first line agent for people whose RA is severe and rapidly progressing. It also used to treat psoriatic arthritis and juvenile idiopathic arthritis. Abatacept has not been tested in pregnant women and it is not known if it is secreted in breast milk; it causes birth defects in rodents when given in very high doses, and is transmitted in rodent breast milk. People should be tested for tuberculosis and any infection cleared before starting abatacept; vaccines should be updated prior to starting abatacept as well. Abacept will likely interfere with any vaccine given while people are taking it. It should not be used in combination with anakinra or TNF antagonists. Because abatacept, anakinra, and TNF antagonists suppress the immune system, using them in combination may significantly increase the risk for severe infections. People have experienced serious infections due to abatacept's suppression of the immune system; some of these infections have been fatal. People with COPD are likely to get lung infections more often than usual. Some people have had anaphylactic reactions to the drug. Abatacept may cause otherwise slow-growing cancers to proliferate and spread, due to suppression of the immune system. Very common adverse effects (occurring in more than 10% of people) include upper respiratory tract infections. Common adverse effects (occurring in between 1% and 10% of people) include lower respiratory tract infections, urinary tract infections, herpes infections, pneumonia, flu, cough, high blood pressure, stomach pain, diarrhea, nausea, vomiting, upset stomach, mouth sores, elevated transaminases, rashes, fatigue, weakness, local injection site reactions, and systemic injection reactions.