Products
Abatacept is commercially available as an injection and infusion preparation (Orencia). It was approved in the United States in 2005 and in the EU and many countries in 2007.
Structure and properties
Abatacept is a recombinant fusion protein with the following components:
- Extracellular domain of CTLA-4 (cytotoxic T-lymphocyte-associated protein 4).
- Modified Fc domain of human immunoglobulin G1 (IgG1) consisting of hinge, CH2, and CH3 domains.
It is produced by biotechnological methods. Abatacept is closely related to belatacept.
Effects
Abatacept (ATC L04AA24) has selective immunosuppressive and anti-inflammatory properties. The effects are due to specific binding to CD80 and CD86 on antigen-presenting cells (APC). This prevents binding to the CD28 receptor on T lymphocytes (T cells). The interaction of CD28 and CD80/CD86 is a condition for T cell activation (called costimulation). Inhibition of costimulation results in reduced T cell activation, T cell proliferation, and antibody formation. Furthermore, cytokine production decreases (TNF-alpha, interferons, interleukins).
Indications
- Rheumatoid arthritis
- Polyarticular juvenile idiopathic arthritis
- Psoriatic arthritis
Dosage
According to the SmPC. The drug is administered either as an intravenous infusion or as a subcutaneous injection.
Contraindications
- Hypersensitivity
- Severe infections, for example, sepsis or opportunistic infections
Full precautions can be found in the drug label.
Interactions
Drug-drug interactions have been described with TNF-alpha inhibitors, vaccines, and immunosuppressants.
Adverse effects
The most common potential adverse effects include headache and nausea. Abatacept increases the risk for infectious diseases.
