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T-cell Co-stimulation Inhibitor (CTLA4-Ig) Pregnancy: C

Abatacept

Brand names: Orencia

Adult dose

Dose: <60 kg: 500 mg IV; 60–100 kg: 750 mg IV; >100 kg: 1000 mg IV at 0, 2, 4 weeks then every 4 weeks; or 125 mg SC weekly
Route: IV infusion or subcutaneous
Frequency: Monthly (IV) or weekly (SC)
Max: 1000 mg/month IV
IV infused over 30 min; SC weekly from 125 mg prefilled syringe; avoid live vaccines

Paediatric dose

Dose: 10 mg/kg
Route: IV
Frequency: every 4 weeks
Max: 1000 mg
Concentration: 250 mg/vial (reconstitute) mg/ml
JIA ≥2 years: IV 10 mg/kg (max 1000 mg) every 4 weeks; SC not licensed under 18 years

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Paediatric weight-based calculator

JIA ≥2 years: IV 10 mg/kg (max 1000 mg) every 4 weeks; SC not licensed under 18 years

Clinical pearls

  • Mechanism: blocks CD80/CD86-CD28 co-stimulation — inhibits T-cell activation without depleting them
  • ASSURE trial: not recommended with TNF inhibitors — significantly more serious infections without benefit
  • Preferred option for RA patients with COPD comorbidity (ORION trial: better tolerability vs. anti-TNF)

Contraindications

  • Active infections
  • Concurrent TNF inhibitors (increased infections)
  • Live vaccines

Side effects

  • Headache
  • Nausea
  • Infections
  • Hypertension
  • Infusion reactions (IV)
  • COPD exacerbation risk

Interactions

  • TNF inhibitors (avoid concurrent use — increased serious infections)
  • Live vaccines (CI)
  • Anakinra (avoid)

Monitoring

  • FBC
  • LFTs
  • Signs of infection
  • COPD exacerbation assessment

Reference: BNFc; BNF 86; NICE TA375; ASSURE trial. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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