Abatacept with Certolizumab Pegol Interaction Details

Brand Names Associated with Abatacept

Brand Names Associated with Certolizumab Pegol

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Feb 23, 2024

Interaction Effect

An increased risk of infection

Interaction Summary

Controlled clinical trials demonstrated that the concomitant use of abatacept and tumor necrosis factor (TNF) antagonists resulted in an increased risk for serious infection and provided no additional benefit. There is insufficient information to evaluate the safety and efficacy of abatacept administered with anakinra or biologics that treat rheumatoid arthritis or psoriatic arthritis. Therefore, concurrent therapy with these agents is not recommended. When treatment is being transitioned from TNF antagonist therapy to abatacept, patients should be monitored for signs of infection[1].

Severity

Major

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Treatment with both abatacept and anakinra or TNF antagonist therapy, including biologics that treat rheumatoid arthritis or psoriatic arthritis, is not recommended. When treatment is being transitioned from TNF antagonist therapy to abatacept, patients should be monitored for signs of infection[1].

Mechanism Of Interaction

Unknown

Literature Reports

A) Concurrent use of abatacept and etanercept rendered no additional efficacy but increased risk of serious infection compared with etanercept alone. In a 1-year, randomized study (N=121) followed by an open-label long-term extension (LTE; n=80), patients with rheumatoid arthritis already being treated with etanercept 25 mg twice/week continued to receive 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). Upon completion of the double-blind phase, patients were eligible for the LTE phase at which time the abatacept dose was increased to approximately 10 mg/kg. At 6 months, the 2 mg/kg abatacept group showed no significant improvement compared with 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, but there was significant difference in modified ACR70 rates (10.6% vs 0%). At 1 year, there were no significant differences in ACR20, 50, or 70 response rates between the two groups. Serious adverse events were more frequent in the 2 mg/kg abatacept group (16.5%) at one year and the 10 mg/kg abatacept group after 2 years of LTE (32.5%) compared with 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 in adults with active rheumatoid arthritis who received concomitant abatacept and a tumor necrosis factor (TNF) antagonist (n=204) compared with TNF antagonist therapy alone (n=134), the incidence of infection (63% vs 43%, respectively) and serious infection (4.4% vs 0.8%, respectively) was greater with concomitant therapy; as well, concomitant therapy provided no additional benefit [3].

References

1 ) Product Information: ORENCIA(R) intravenous, subcutaneous injection, abatacept intravenous, subcutaneous injection. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2020.

2 ) 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 Abstract: http://www.ncbi.nlm.nih.gov/...

3 ) Product Information: ORENCIA(R) IV powder, abatacept IV powder. Bristol-Myers Squibb, Princeton, NJ, 2008.

Abatacept Overview

• Abatacept is used:

  • alone or in combination with other medications to reduce the pain, swelling, difficulty with daily activities, and joint damage caused by rheumatoid arthritis (a condition in which the body attacks its own joints causing pain, swelling, and loss of function) in adults who have not been helped by other medications.

  • alone or in combination with methotrexate (Otrexup, Rasuvo, Reditrex, Trexall, Xatmep) to treat polyarticular juvenile idiopathic arthritis (PJIA; a type of childhood arthritis that affects five or more joints during the first six months of the condition, causing pain, swelling, and loss of function) in children 2 years of age or older.

  • alone or in combination with other medications to treat psoriatic arthritis (condition that causes joint pain and swelling and scales on the skin) in adults.

  • in combination with a calcineurin inhibitor (e.g., cyclosporine [Gengraf, Neoral, Sandimmune], tacrolimus [Astagraf, Prograf]) and methotrexate to prevent graft-versus-host disease (GVHD; a complication of hematopoietic stem-cell transplant [HSCT; a procedure that replaces diseased bone marrow with healthy bone marrow]) in adults and children 2 years of age and older.

• Abatacept is in a class of medications called selective costimulation modulators (immunomodulators). It works by blocking the activity of T-cells, a type of immune cell in the body that causes swelling and joint damage in people who have arthritis.

Certolizumab Pegol Overview

• Certolizumab injection is used to relieve the symptoms of certain autoimmune disorders (conditions in which the immune system attacks healthy parts of the body and causes pain, swelling, and damage) including the following:

  • Crohn's disease (a condition in which the body attacks the lining of the digestive tract, causing pain, diarrhea, weight loss, and fever) that has not improved when treated with other medications,

  • rheumatoid arthritis (a condition in which the body attacks its own joints, causing pain, swelling, and loss of function),

  • psoriatic arthritis (a condition that causes joint pain and swelling and scales on the skin),

  • active ankylosing spondylitis (a condition in which the body attacks the joints of the spine and other areas causing pain, swelling, and joint damage) with changes seen on X-ray,

  • active non-radiographic axial spondyloarthritis (a condition in which the body attacks the joints of the spine and other areas causing pain and signs of swelling), but without changes seen on X-ray,

  • plaque psoriasis (a skin disease in which red, scaly patches form on some areas of the body) in people who may benefit from medications or phototherapy (a treatment that involves exposing the skin to ultraviolet light).

• Certolizumab injection is in a class of medications called tumor necrosis factor (TNF) inhibitors. It works by blocking the activity of TNF, a substance in the body that causes inflammation.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.