Abatacept and Anakinra: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 16, 2026 · Source data updated Jul 16, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Anakinra
Abatacept
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Anakinra (Kineret) and abatacept (Orencia) are both medicines that calm down an overactive immune system. They work in different ways, but they both turn down some of your body's defenses. When you take two immune-lowering drugs together, your body may have a harder time fighting off germs, so your chance of getting a serious infection can go up. In studies, combining this type of drug did not give people any extra benefit, just extra risk.
The good news is this is easy to manage. Don't stop either medicine on your own. Talk with your doctor or pharmacist, since they usually recommend not using these two at the same time and can help you find a safer plan.
Effect: Additive immunosuppression with increased risk of serious infection and no added efficacy.
- Mechanism: Unknown/pharmacodynamic. Both agents suppress immune activity (anakinra is an IL-1 receptor antagonist; abatacept is a T-cell costimulation modulator). Neither is a prodrug; this is a PD interaction, not PK.
- Evidence: Theoretical for this specific pair; extrapolated from controlled trials of abatacept plus TNF antagonists showing increased serious infection without additional benefit.
- Onset: Unspecified.
- Management: Concurrent use not recommended. When transitioning from TNF antagonist therapy to abatacept, monitor for signs of infection.
What happens
An increased risk of infection
Interaction Deep Dive
In controlled clinical studies, giving abatacept together with tumor necrosis factor (TNF) antagonists was associated with a higher likelihood of serious infection while offering no added benefit. Available data are inadequate to assess the safety and efficacy of combining abatacept with anakinra or with biologic agents used for rheumatoid arthritis or psoriatic arthritis. For this reason, using these medications alongside abatacept is not advised. During a switch from TNF antagonist treatment to abatacept, patients should be watched for indications of infection1.
Why it happens (mechanism)
Unknown
How to manage this interaction
The usual approach: Care teams generally do not use anakinra and abatacept together because the combination raises infection risk without adding benefit. Your prescriber may choose one agent instead of both, or plan a careful transition.
- Keep taking your medicines exactly as prescribed until your care team tells you otherwise.
- If you are switching from a TNF antagonist to abatacept, your team may monitor you more closely for signs of infection.
- Watch for fever, chills, cough, or any wound that is not healing, and report these promptly.
- Ask your pharmacist or doctor before adding any new immune-lowering biologic.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) Using abatacept together with etanercept produced no extra efficacy but raised the risk of serious infection compared with etanercept by itself. In a 1-year randomized study (N=121) followed by an open-label long-term extension (LTE; n=80), rheumatoid arthritis patients who were already receiving etanercept 25 mg twice/week continued their etanercept and were randomized to receive either abatacept 2 mg/kg IV on days 1, 15, and 30, and then every 4 weeks (n=85) or placebo (n=36). After the double-blind phase concluded, patients qualified for the LTE phase, at which point the abatacept dose was raised to about 10 mg/kg. At 6 months, the 2 mg/kg abatacept group demonstrated no significant improvement over the placebo group in modified American College of Rheumatology 20% (ACR20; 48.2% vs 30.6%) or ACR50 (25.9% vs 19.4%) response rates, though a significant difference was seen in modified ACR70 rates (10.6% vs 0%). At 1 year, no significant differences in ACR20, 50, or 70 response rates were observed between the two groups. Serious adverse events occurred more often in the 2 mg/kg abatacept group (16.5%) at one year and in the 10 mg/kg abatacept group after 2 years of LTE (32.5%) than in the placebo group (2.8%). Serious infections at 1 year were reported in 3.5% of the 2 mg/kg abatacept group and 0% of the placebo group 2.
b) In controlled clinical trials involving adults with active rheumatoid arthritis who received abatacept together with a tumor necrosis factor (TNF) antagonist (n=204) compared with TNF antagonist therapy alone (n=134), the rate of infection (63% vs 43%, respectively) and serious infection (4.4% vs 0.8%, respectively) was higher with the combined therapy; furthermore, the combined therapy offered no additional benefit 1.
Common questions
Can I take Abatacept and Anakinra together?
Using anakinra and abatacept together raises your risk of serious infection without added benefit, so this combination is generally not recommended. Do not change anything on your own; talk with your doctor or pharmacist about the safest option. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Abatacept and Anakinra interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Abatacept and Anakinra interaction managed?
The usual approach: Care teams generally do not use anakinra and abatacept together because the combination raises infection risk without adding benefit. Your prescriber may choose one agent instead of both, or plan a careful transition. Keep taking your medicines exactly as prescribed until your care team tells you otherwise. If you are switching from a TNF antagonist to abatacept, your team may… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Abatacept or Anakinra need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (2)
- Product Information: ORENCIA(R) intravenous, subcutaneous injection, abatacept intravenous, subcutaneous injection. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2020. DailyMed
- Weinblatt M, Schiff M, Goldman A, et al: Selective costimulation modulation using abatacept in patients with active rheumatoid arthritis while receiving etanercept: a randomised clinical trial. Ann Rheum Dis 2007; 66(2):228-234. PubMed
Keep reading about Anakinra
Keep reading about Abatacept
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