What is Orencia?

Orencia Dosage, forms & strengths

Medically reviewed by Jamie Winn, PharmD

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Orencia (abatacept) is an injectable disease-modifying antirheumatic drug (DMARD) that is manufactured by Bristol-Myers Squibb. It is the first selective T cell costimulation modulator. It is used to treat adult rheumatoid arthritis and psoriatic arthritis. It is also used to treat a type of juvenile arthritis in children 2 years of age and older. Orencia can be administered as a subcutaneous injection or an intravenous (IV) infusion.

What does Orencia treat?

Orencia is approved by the U.S. Food and Drug Administration (FDA) to treat adults with active rheumatoid arthritis (RA) and active psoriatic arthritis (PsA) and children at least 2 years of age with active polyarticular juvenile idiopathic arthritis (pJIA). It can also be used to prevent acute graft-versus-host disease (aGVHD) when used along with a calcineurin inhibitor and methotrexate following a hematopoietic stem cell transplant (HSCT).

What is Orencia’s mechanism of action?

Orencia is a DMARD that works by binding to certain proteins to block the activity of T cells (T lymphocytes). T cells are immune system cells that help your body fight infections. Autoimmune diseases such as RA, PsA, and pJIA are a result of these cells attacking healthy cells and causing inflammation, swelling, and joint damage. Blocking T cells help reduce inflammation and prevent joint damage and other complications.

Orencia dosage forms and strengths

250mg of lyophilized powder for reconstitution and intravenous infusion
50mg/0.4ml, 87.5mg/0.7ml, and 125mg/ml in a single-dose prefilled syringe
125mg/mL in a single-dose prefilled ClickJect autoinjector

Orencia dosage

IV dose for adults with RA or PsA

Orencia is given as a 30-minute infusion at 0, 2, and 4 weeks, and then every 4 weeks thereafter based on your body weight:

Less than 60kg: 500mg
60kg to 100kg: 750mg
More than 100kg: 1,000mg

Subcutaneous dose for adults with RA

Your doctor may give you a loading dose as a single IV infusion based on the body weight categories above. The recommended dose of Orencia is 125mg injected under the skin once weekly.

Subcutaneous dose for adults with PsA

The recommended dose of Orencia is 125mg given by subcutaneous injection once weekly without an IV loading dose.

IV dose for pediatric patients 6 years of age and older with pJIA

The recommended dose for pediatric patients weighing less than 75kg is 10mg/kg of Orencia given as an IV infusion. Pediatric patients that weigh 75kg and over should be dosed using the adult IV dosing regimen. The dose should not exceed 1,000mg. After the first dose, you will receive infusions at 2 and 4 weeks and then every 4 weeks thereafter.

Subcutaneous dose for pediatric patients 2 years of age and older with pJIA

Orencia should be given without an IV loading dose. The recommended dose is based on body weight and should be given as an injection under the skin once weekly:

10kg to less than 25kg: 50mg
25kg to less than50 kg: 87.5mg
50kg or more: 125mg

Intravenous dose for the prophylaxis of GVHD

For patients aged 2 to less than 6, give 15mg/kg of Orencia as a 60-minute IV infusion on the day before stem cell transplantation, followed by a 12mg/kg infusion on Days 5, 14, and 28 after the transplant.

For patients 6 years of age and older, give 10mg/kg of Orencia up to a maximum dose of 1,000mg. It is administered as a 60-minute IV infusion on the day before stem cell transplantation, followed by an infusion on Days 5, 14, and 28 after the transplant.

Orencia dosage restrictions

No guidelines or dose reduction recommendations are available for patients with liver or kidney impairment, and it appears no adjustments are needed.

How to take Orencia

Read the Prescribing Information, Instructions for Use, and Medication Guide that comes with this medication.
You may receive this medication from your doctor as a 30-minute or 60-minute intravenous infusion, depending on the condition being treated.
You may also be given this medication as a subcutaneous injection (under the skin) at home by yourself or a caregiver via an Orencia prefilled syringe or prefilled ClickJect autoinjector. Your doctor will demonstrate to you or your caregiver how to prepare and inject Orencia.

Orencia dosage FAQs

What are some side effects of Orencia?

The most common adverse reactions of Orencia include:

Injection site reactions
Headache
Infections
Nausea
Dizziness
Cough
Back pain
Hypertension
Upset stomach
Abdominal pain
Sore throat
Itching and rash

Orencia can sometimes cause more serious side effects, including:

Severe, life-threatening allergic reactions, including anaphylaxis (hives, swelling of your face or throat, and trouble breathing)
Increased incidence of serious infections
Hepatitis B reactivation
Increased incidence of malignancies, including skin cancer
New or worsening psoriasis
Inflammation of the blood vessels (vasculitis)

Contact your healthcare professional for medical advice about any adverse events you experience while taking Orencia. You can report your adverse effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

What are some drug interactions with Orencia?

The concomitant use of Orencia with other drugs can change how they work or increase the frequency and severity of side effects. You should ask your healthcare professional if any of the prescription drugs, over-the-counter medications, vitamins, and herbal supplements you take may interact with this medication, such as live vaccines or immunosuppressants such as TNF antagonists, other biologic RA/PsA therapy or JAK inhibitors.

Are there any contraindications for Orencia?

You should avoid the use of Orencia if you have a known hypersensitivity reaction to abatacept or any of the inactive ingredients in this product.

What should you tell your doctor before starting Orencia?

Before beginning Orencia, make sure your doctor is aware of your medical conditions, including:

Active infection
Hepatitis B
Tuberculosis (your doctor should do a skin test to check for TB before starting Orencia)
History of Epstein-Barr Virus or cytomegalovirus
Recent or scheduled surgery or vaccination
Chronic obstructive pulmonary disease (COPD)
Diabetes, as Orencia for intravenous administration, contains maltose and can alter blood sugar readings
History of skin cancer
Are pregnant, plan on becoming pregnant, or are breastfeeding

Is it safe to use Orencia while pregnant or breastfeeding?

The effects of using Orencia during pregnancy are not known. There is a pregnancy exposure registry that monitors outcomes in pregnant women who take Orencia. You can enroll by calling 1-877-311-8972. It is not known if Orencia is found in breast milk during lactation or the effects it may have on a breastfed infant. You should always discuss the risks and benefits of any medication with your healthcare provider if you are pregnant, plan on becoming pregnant, or are breastfeeding.

How effective is Orencia in treating rheumatoid arthritis?

According to the package insert, Orencia was given by IV infusion along with methotrexate to people with moderate to severe RA. A 20% reduction of RA symptoms was seen in 62% of patients taking Orencia with methotrexate after 3 months of treatment. In patients taking a placebo with methotrexate, 37% had the same result.

Can I receive vaccines while taking Orencia?

You should not receive live vaccines while on Orencia or for 3 months after discontinuation.

Does Orencia cause weight gain?

No, weight gain was not a common side effect seen in clinical trials.

What is the average price of Orencia?

Currently, no generic Orencia is available, and the brand name is very expensive. The average cost of 4 prefilled syringes of Orencia 125mg/1ml is almost $6,000.

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The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.