Clinical use of Abatacept
For the management of the signs and symptoms of moderate-to-severe active rheumatoid arthritis, inducing major clinical response, slowing the progression of structural damage, and improving physical function in adult patients.
It is indicated both as a monotherapy and for use in combination with a continued regimen of DMARDs (not including TNF antagonists).
Also used for the management of the signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in children.
- Moderate juvenile idiopathic arthritis
- Moderate rheumatoid arthritis
- Severe juvenile idiopathic arthritis
- Severe rheumatoid arthritis
Abatacept is the first in a new class of drugs known as Selective Co-stimulation Modulators.
Recombinant fusion protein
- Known as a recombinant fusion protein, the drug consists of the extracellular domain of human cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) linked to a modified Fc portion of human immunoglobulin G1 (IgG1.
- The Fc portion of the drug consists of the hinge region, the CH2 domain, and the CH3 domain of IgG1.
How does it work in RA?
- Although there are multiple pathways and cell types involved in the pathogenesis of rheumatoid arthritis, evidence suggests that T-cell activation may play an important role in the immunopathology of the disease.
- Ordinarily, full T-cell activation requires binding of the T-cell receptor to an antigen-MHC complex on the antigen-presenting cell as well as a co-stimulatory signal provided by the binding of the CD28 protein on the surface of the T-cell with the CD80/86 proteins on the surface of the antigen-presenting cell.
- CTLA4 is a naturally occurring protein which is expressed on the surface of T-cells some hours or days after full T-cell activation and is capable of binding to CD80/86 on antigen-presenting cells with much greater affinity than CD28.
Binding of CTLA4-Ig to CD80/86 provides a negative feedback mechanism which results in T-cell deactivation.
Abatacept is marketed as Orencia in the United States and other countries.
Mechanism of action of Abatacept
- Abatacept is a selective costimulation modulator, like CTLA-4, the drug has shown to inhibit T-cell (T lymphocyte) activation by binding to CD80 and CD86, thereby blocking interaction with CD28.
- Blockade of this interaction has been shown to inhibit the delivery of the second co-stimulatory signal required for optimal activation of T-cells.
- This results in the inhibition of autoimmune T-Cell activation that has been implicated in the pathogenesis of rheumatoid arthritis.
The annual drug cost is estimated to be about $18,663 per patient in the United States.
Frequently asked questions
- Is abatacept an immunosuppressant?
- What are the side effects of abatacept?
- Does Orencia weaken the immune system?
- How does abatacept work in rheumatoid arthritis?
- What to avoid while on immunosuppressants?
- What is the best medicine for autoimmune disease?
- How long does it take for abatacept to work?
- What is the best pain medication for rheumatoid arthritis?
- Can you live normal life with RA?
- What happens if you stop taking Orencia?
- What is the difference between Orencia and Humira?
- Does Orencia affect the liver?
- Does abatacept cause weight gain?
- How does Orencia work in the body?
- Is Orencia an anti inflammatory?
- What is the safest drug for rheumatoid arthritis?
- Why are biologics so expensive?
- What is the best biologic for rheumatoid arthritis?
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