T-Cell Co-Stimulatory Inhibitors

Administration: Subcutaneous injection. Sometimes given as IV infusion.

Dose: 125mg subcutaneously once weekly

Time to response: 2 weeks to 3 months

Indications: Rheumatoid Arthritis.

Contraindications:

• Active infection including HBV & HIV.
• Active/untreated latent TB.
• Septic arthritis in last 12 months.
• Breastfeeding.

Cautions:

• Previous HBV.
• History of malignancy or when considering continuing treatment in patients with malignancy.
• Only use during pregnancy when risk to mother justifies risk to foetus.
• COPD – monitor for worsening of respiratory status.

Monitoring:

• FBC, U&E, LFTs every 3-6 months

Vaccinations:

• Avoid live attenuated vaccines.
• Offer annual influenza vaccination.
• In those who are biologic naïve pneumococcal vaccination and Sars-Cov-2 vaccination should ideally be performed at least 2 weeks before commencing biologic treatment.
• Assuming no contraindications before starting treatment:
  • Patients >50 should undergo vaccination against HZV.
  • Those who are varicella zoster negative should be offered varicella vaccination.

In the event of:

• Injection site reaction – usually settles without further intervention.
• Sore throat/fever/bruising/pallor – stop ABATACEPT and check FBC.
• Serious infection – stop ABATACEPT and restart once infection resolved.
• Surgery – stop 1 week prior to surgery and resume after wound healing.
• Increasing dyspnoea – stop ABATACEPT and arrange CXR.

Stop ABATACEPT if:

• WBC < 3.5 x10⁹/L
• ALT/AST > two times normal
• Neutrophils < 2.0 x 10⁹/l
• Platelets <150 x 10⁹/l