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INTRODUCTION

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abatacept (a-bat-a-sept)

Orencia

Classification

Therapeutic: antirheumatics

Pharmacologic: fusion proteins

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Indications
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Reduction of signs/symptoms and disease progression in moderate to severely active rheumatoid arthritis which has progressed despite use of previous disease-modifying antirheumatic drug (DMARD).

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Action
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Inhibits T-cell activation (and the inflammatory process) by binding to specific receptors. Therapeutic Effects: Decreased progression of rheumatoid arthritis.

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Adverse Reactions/Side Effects
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CNS: headache, dizziness. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS, INFECTIONS, infusion-related events.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Be especially alert for allergic-like responses that occur during and after administration (infusion-related events). Notify physician or nursing staff immediately if any hypersensitivity reactions occur.

  • Periodically assess impairments (pain, range of motion), functional ability, and disability to help document whether antirheumatic drug therapy is successful.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Implement appropriate manual therapy techniques, physical agents, therapeutic exercises, and orthotic/assistive devices to reduce pain, improve function, and augment the effects of antirheumatic drug therapy.

  • Help patients with arthritis explore other nonpharmacologic methods to reduce chronic arthritis pain, such as relaxation techniques, exercise, counseling, and so forth.

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Patient/Client-Related Instruction
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  • Advise patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

  • Instruct patient to report other troublesome side effects, including severe or prolonged headache.

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Pharmacokinetics
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Absorption: IV administration results in complete bioavailability.

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Distribution: Unknown.

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Metabolism and Excretion: Unknown.

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Half-life: 13 days.

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TIME/ACTION PROFILE (improvement in symptoms)

ROUTE ONSET PEAK DURATION
IV within 15 days–3 mo 6–12 mo 3 yr (maintenance of response)

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Concurrent use of tumor necrosis factor (TNF) antagonists or anakinra; Lactation: Discontinue drug or provide formula.

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Use Cautiously in: Patients with chronic obstructive pulmonary disease (↑ risk of exacerbations and other adverse events); Geri: ↑ risk of adverse reactions; Pedi: Safe use in children not established; OB: Use in pregnancy only if clearly needed.

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Interactions
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Drug-Drug: Concurrent use with tumor necrosis factor (TNF) antagonists may ↑ risk and severity of infections. May ↑ incidence and risk of adverse reactions from live virus vaccines.

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