Abatacept for children and young people

JIA artwork

Picture by Phoebe Howat, age 6

Biologic drugs explained


Abatacept is a ‘biologic’ drug. Biologic drugs are often referred to as ‘targeted therapies’ because they work on specific cells of the immune system. Abatacept works on the T-cells. 

T-cells are one type of white blood cell, called lymphocytes. T-cells are part of the normal immune system that co-ordinate the process of inflammation. In JIA, the inflammatory process (signs of which are pain, swelling, redness and heat in joints) is in ‘overdrive’ and needs to be controlled to prevent damage to joints and other unwanted effects. Normally the body should be able to control the degree of inflammation and abatacept was developed to mimic this naturally occurring process. 

The inflammatory process in arthritis is seen and felt mostly in the joints as pain and swelling. However, the high levels of inflammation are in the blood stream and therefore will affect the general wellbeing by causing often significant fatigue, lethargy and feeling ‘under the weather’.

Background

Abatacept is the first drug developed to control the T cells of the immune system. It has been used for adults with rheumatoid arthritis since 2006 and in children with polyarthritis over 6 years of age since 2008. The National Institute for Health and Care Excellence (NICE) are currently developing their guidance on the use of abatacept in the UK, with an anticipated publication date of February 2016. In adults and children it is available to those with an inadequate response to disease modifying anti-rheumatic drugs (DMARDs) including at least one anti-TNF drug. Abatacept may be prescribed alongside methotrexate.

How long does abatacept take to work?

Abatacept may take several weeks to show an improvement (up to 3 months). Treatment needs to be reviewed if there is no response within 6 months.

When can abatacept be prescribed?

Abatacept can only be prescribed under specialist medical supervision from a tertiary/specialist centre for the treatment of juvenile idiopathic arthritis according to strict guidelines. When these guidelines are met, it can be prescribed on its own or together with methotrexate.

There will always be pre-treatment screening, particularly to establish if there is any history of tuberculosis (as this can be re-activated by abatacept). A record is taken of the vaccinations completed and any other information the prescribing specialist requires.

Whether you are a young person with JIA or the parent of a child with JIA it is important that you understand the intended treatment and any possible precautions. Equally important is a discussion about the evidence of the benefits of abatacept and the need for the ongoing research into the long term unknown facts.

The prescribing doctor will register the child/young person (with the consent of the parent(s) in the case of children) with the Biologics Registry of the British Society for Paediatric and Adolescent Rheumatology (BSPAR). This is a database that stores information on the use of biologic drugs and helps to increase the knowledge of these treatments. There is more confidence in the benefit of a treatment when increasing numbers of patients take it for increasing lengths of time without significant side effects.

How is Abatacept given?

Abatacept is given as a 30-60 minute intra-venous infusion in hospital. An intra-venous infusion means that a drug can be given slowly over a specific time directly into a vein though small plastic tubing (called a canula), connected to a large syringe or a bag of fluid hanging from a stand. This procedure is usually into a vein in the arm.

The treatment is repeated 2 weeks later and thereafter every 4 weeks. Reactions to the drug during the infusion are uncommon.

Regular blood test monitoring is required; the frequency of which will depend on the prescribing specialist’s advice.

Possible side effects

As with any medication, abatacept has a number of possible side effects, although it is important to remember that these are only potential side effects and that the most common side effects will be the more minor ones.

1. Infections

Abatacept, like other biologic drugs, has been associated with an increased susceptibility to infections; sometimes these can be severe eg. re-activation of tuberculosis or milder infections such as skin infections. Due to the risk of infection, tattoos and body piercings are not recommended.

2. Other possible side effects include:

  • Most commonly, headache, sore throat, nausea, diarrhoea, abdominal pain, fever, cough 
  • Serious effects can be pneumonia and other infections and allergic reactions to the infusion 

More information on side effects can be found in the patient information leaflet for Abatacept

Remember to report any concerns about possible side effects to the doctors or nurses

Abatacept with other medicines

There are currently no specific prescribed medicines to be avoided when taking abatacept, but remember to take care when using any other medications or complementary therapies (even if bought ‘over the counter’ for colds or flu). Remember to check with a doctor, nurse or pharmacist that they are safe to take with abatacept and any other medication taken.

Only one biologic drug is prescribed at any one time. Abatacept (a biologic drug) prescribed alongside methotrexate (a standard DMARD) is a commonly used combination.

Abatacept and immunisation/vaccination

Live vaccines [measles, mumps, rubella (MMR), chickenpox, oral polio (NOT injectable polio), BCG, oral typhoid and yellow fever] cannot be given to anyone already taking abatacept. If abatacept has not yet been started it is important to seek advice on how long a gap to leave after having a live vaccine.

Flu vaccine is now available in two forms, an injection and a nasal spray. Unlike the injection, the nasal spray is a live vaccine. There is limited research evidence around live vaccines in people with a lowered immune system (due to their medication). It is therefore important to discuss with the healthcare team which of these options would be best.

Vaccination of close family members can help to protect someone with a lowered immune system.

Abatacept and pregnancy

There is not sufficient research information to give advice that either pregnancy or breast feeding is safe. 
A man or a woman taking abatacept should use reliable contraception during treatment and for 3 weeks after the last dose before planning to start a family. 
Remember to ask your doctor or clinical nurse specialist if you need any further advice.

Abatacept and alcohol

Alcohol can be consumed when taking abatacept. However, caution may be required when taking other medications alongside this drug, for example methotrexate. Please see our separate articles on other JIA medications.

Hints and Tips

  • Stay safe on abatacept by remembering to have regular blood test monitoring as advised by the consultant or clinical nurse specialist. These will usually be taken at the time of the infusion.

Table summary 

Drug name How the drug is taken How it works Blood tests mandatory?
Abatacept (ABA) Infusion Reduces over activity of the immune system by targeting T-cells Yes- every 3 months initially

References available on request

By retired rheumatology clinical nurse specialist Nicky Kennedy BSc RN QN HV

Original article: 03/12/2015 
Reviewed: N/A 
Next review due: 03/12/2018