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Abatacept (Orencia)
Available:
In 250 mg vials
Dose:
Orencia is given at a dose based on body weight, roughly 10
mg/kg. Typically, a
dose of 500 mg is given to a patient weighing 132 lbs. or
less, 750 mg to an individual weighing between 132 and 200
lbs., and 1 gram to anyone over 200 lbs.
Infusions are given every 30 days after three initial
loading doses, each given two weeks apart.
Cost:
$5,000 per dose
Indications:
Orencia is
indicated for the treatment of rheumatoid arthritis after
failing at least one other DMARD or TNF inhibitor
Side
effects: The most common reported
side effects include headache, upper respiratory infection,
and nausea. Infusion reactions, while uncommon, may be
accompanied by dizziness, high blood pressure, cough,
shortness of breath, or headache. Caution should be used in
patients with a history of chronic obstructive pulmonary
disease (COPD or emphysema) and those with a history of
frequent infections.
Monitoring:
As with patients
taking other biologic response modifiers, a blood count is
typically drawn at least every 6 months. Most individuals
will be taking other disease modifying drugs that will
require other blood work to be done routinely to monitor for
safety. Screening patients in advance for TB and hepatitis
is recommended.
Important
points to know: This medication
appears to be associated with a smaller risk of infection
than what is seen with TNF antagonists. Still, it is
recommended that Oeancia not be utilized with TNF antagonist
therapy, as studies have shown increased infection risk but
no significant additional benefit when these drugs are
combined. Maximal responses to this drug may not be seen for
three to six months.
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