A T-cell co-stimulation modulator (biologic)
Abatacept
A biologic that calms the immune system's T-cells, used mainly for rheumatoid arthritis.
What is Abatacept?
Abatacept is a biologic medicine used mainly for rheumatoid arthritis and some other inflammatory arthritis, including in children. Rather than blocking TNF, it works further back by calming down the immune system's T-cells, reducing the inflammation that damages joints. It can be given as a drip into a vein or as an injection under the skin, and is not a tablet. Because it dampens the immune system, serious infection is the main risk, so you are screened for tuberculosis and hepatitis B and C before starting. Live vaccines must be avoided while on it, but routine jabs such as the flu vaccine are encouraged. It is sold under the brand name Orencia.
Education and reference only. This is a plain-language guide to Abatacept — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Abatacept is a biologic medicine, made using living cells rather than as a chemical tablet, used mainly for rheumatoid arthritis and some other forms of inflammatory arthritis, including in children. Unlike the anti-TNF biologics, it works on a different part of the immune system: it dials down T-cells, a type of immune cell that helps drive the inflammation. It can be given as an infusion (a drip) into a vein or as an injection under the skin that people can often do at home. It is sold under the brand name Orencia.
How it works
Abatacept works on the immune system's T-cells, the cells that help orchestrate the inflammatory attack on the joints. It blocks one of the 'go' signals that T-cells need to become fully active, calming the immune response further upstream than the anti-TNF medicines. This reduces the joint swelling, pain, stiffness and damage of inflammatory arthritis. Because it quietens the immune system, the body's defence against infection is lowered, which is why infections such as tuberculosis can reactivate. The benefit builds over weeks and is reviewed at follow-up.
Company & origin
Originated / developed by: Bristol Myers Squibb.
A biologic used in the UK for rheumatoid arthritis and some other inflammatory arthritis.
What it treats
Conditions Abatacept is used for
Practical use
How to take Abatacept
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It can be given as a drip into a vein at a clinic or as an injection under the skin, not as a tablet.
- If you have the under-the-skin form, you or a carer can usually be taught to inject at home, rotating the site each time.
- If you have the drip, attend all your scheduled infusion appointments and expect to be monitored during them.
- Use it exactly as prescribed and keep going even when you feel well, as it controls a long-term condition.
- Avoid live vaccines while on treatment and tell any healthcare professional that you take a biologic.
- Contact your team promptly if you develop a fever, persistent cough, night sweats or other signs of infection.
Weighing it up
Advantages & disadvantages of Abatacept
Advantages
- Works on a different part of the immune system, so it can help when anti-TNF medicines have not.
- Offers a choice of a drip or an under-the-skin injection that can be done at home.
- Effective at reducing joint pain, swelling and stiffness in rheumatoid arthritis, including in children.
Disadvantages
- Lowers the body's defences, so serious infections are more likely and need prompt attention.
- Requires tuberculosis and hepatitis screening before starting and ongoing monitoring.
- Cannot be given with live vaccines, and used cautiously in people with long-term lung conditions.
Practical use
Good to know
Abatacept dampens the immune system, so serious infection is the most important risk to understand. Before starting, you will be screened for tuberculosis and for hepatitis B and C, as these can reactivate during treatment. Live vaccines must be avoided while on it, but other vaccines such as the annual flu jab and pneumonia vaccine are encouraged and are best arranged before starting where possible. Report signs of infection, such as fever, persistent cough or night sweats, promptly. Because it works on T-cells rather than TNF, it is sometimes chosen when an anti-TNF medicine has not worked or is not suitable. It is used with caution in people with long-term lung conditions such as COPD, and infusion or injection-site reactions can occur. You can choose, with your team, between the drip and the under-the-skin injection depending on what suits you.
Who should not take it / use with caution
- People with an active serious infection, including active or untreated tuberculosis, should not start it until this is treated.
- It should not be used by people who have had a severe allergic reaction to abatacept or its ingredients.
- It is used with particular caution in people with long-term lung conditions such as COPD.
Monitoring
- Screening for tuberculosis and hepatitis B and C before starting, with ongoing watch for infection.
- Regular review of how well the arthritis is responding and whether to continue.
- Blood tests as advised, particularly if combined with other medicines such as methotrexate.
Side effects
- An increased risk of infections such as colds, chest and urinary infections, and infusion or injection-site reactions.
- Headache, nausea, dizziness and feeling generally unwell can occur.
- Less commonly, reactivation of tuberculosis or hepatitis B, and rare serious infections or allergic reactions needing urgent care.
Key interactions
- Should not be combined with live vaccines, which must be avoided during treatment.
- Combining it with anti-TNF or other immune-suppressing biologics raises infection risk and is generally avoided.
- It is often used alongside methotrexate in rheumatoid arthritis, which your team will monitor together.
Available as: Infusion (drip) into a vein, or a pre-filled pen or syringe for injection under the skin.
Answers
Abatacept: frequently asked questions
How is abatacept different from anti-TNF medicines?
Instead of blocking TNF, it works on the immune system's T-cells, calming the inflammatory response further upstream, which is why it can help when an anti-TNF medicine has not.
How is it given?
It can be given as a drip into a vein at a clinic or as an injection under the skin that people can often do at home; it is not a tablet.
Why do I need screening before starting?
Because abatacept dampens the immune system, you are screened for tuberculosis and hepatitis B and C beforehand, as these can reactivate during treatment.
Can I have vaccinations on it?
Live vaccines must be avoided, but non-live vaccines such as the flu and pneumonia jabs are encouraged, ideally before you start.
What if I think I am getting an infection?
Contact your healthcare team promptly if you develop a fever, persistent cough, night sweats or other signs of infection, as these need checking.
Authoritative sources
- BNF
- NICE CKS
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