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T-cell Co-stimulation Inhibitor (CTLA4-Ig)

Abatacept

Brand names: Orencia

Abatacept is a biologic disease-modifying antirheumatic drug (a selective T-cell co-stimulation modulator) used for moderate to severe rheumatoid arthritis and certain other autoimmune conditions.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It is a fusion protein that binds CD80/CD86 on antigen-presenting cells, blocking the CD28 co-stimulatory signal required for full T-lymphocyte activation.

Prescribing in practice

  • Screen for and treat latent tuberculosis and other chronic infections before starting, and avoid initiation during active serious infection because of increased infection risk.
  • Avoid combining with TNF inhibitors or other biologics because of the increased risk of serious infection without added benefit.
  • Live vaccines should not be given during treatment or for a period afterwards; update vaccinations before starting where possible.

Monitoring

Monitor for signs of infection throughout treatment and review COPD patients and those with chronic respiratory disease closely, as exacerbations have been reported.

Counselling the patient

  • Tell your team promptly about fever, persistent cough or any signs of infection.
  • Avoid live vaccines and discuss any planned immunisations with your specialist.
  • Carry a biologic alert card and keep your screening and follow-up appointments.

Evidence & guidelines

NICE technology appraisals support abatacept for rheumatoid arthritis in defined patient groups after inadequate response to conventional DMARDs.

Reference: NICE TA375; ASSURE trial; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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