Abatacept and Infliximab: 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
Abatacept
Infliximab
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.
Both abatacept (Orencia) and infliximab (Remicade and similar brands) calm down parts of your immune system to treat conditions like rheumatoid arthritis. That is helpful for joint swelling, but taking them together turns the immune system down too far. In studies, people who used both had a higher chance of getting a serious infection, and the combination did not work any better than one drug alone.
Because of this, doctors generally do not use these two at the same time. The good news is your care team knows about this and can manage it. If you are switching from one to the other, they will keep an eye out for any signs of infection like fever, chills, or a cough.
Effect: Additive immunosuppression with abatacept (T-cell costimulation modulator) plus infliximab (TNF antagonist), increasing the risk of serious infection with no added therapeutic benefit.
- Direction: Pharmacodynamic (not a metabolic/PK interaction); neither agent is metabolized in a way that alters the other's exposure.
- Mechanism: Unknown precise mechanism; presumed compounded suppression of immune defenses.
- Evidence: Theoretical designation on file, though supported by controlled trial signals of increased serious infection.
- Management: Concurrent use not recommended. If transitioning off a TNF antagonist to abatacept, monitor for signs/symptoms 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 shown to raise the likelihood of serious infection while offering no added benefit. 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, so combining abatacept with these medications is not advised. During a switch from TNF antagonist therapy to abatacept, patients should be watched for indications of infection1.
Why it happens (mechanism)
Unknown
How to manage this interaction
What your care team typically does:
- Generally avoids using abatacept and infliximab (or other TNF blockers) at the same time, since combining them raises infection risk without extra benefit.
- When switching you from a TNF blocker like infliximab over to abatacept, they will monitor you more closely for signs of infection.
What you should do:
- Keep taking your medicines exactly as prescribed and do not stop either one on your own.
- Tell your pharmacist or prescriber if you see both drugs on your list, or if you develop fever, chills, cough, or any new signs of infection.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) Using abatacept together with etanercept provided no extra efficacy but raised the risk of serious infection relative to etanercept by itself. In a 1-year, randomized study (N=121) followed by an open-label long-term extension (LTE; n=80), patients with rheumatoid arthritis who were already receiving etanercept 25 mg twice/week continued the 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 finishing the double-blind phase, patients could enter 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 did not show 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 there was a significant difference in modified ACR70 rates (10.6% vs 0%). At 1 year, no significant differences in ACR20, 50, or 70 response rates were seen 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%). At 1 year, serious infections were reported in 3.5% of the 2 mg/kg abatacept group and in 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 of serious infection (4.4% vs 0.8%, respectively) was higher with the combined treatment; moreover, the combined treatment gave no added benefit 1.
Common questions
Can I take Abatacept and Infliximab together?
Using abatacept and infliximab together raises the risk of serious infection with no added benefit, so this combination is generally not recommended; talk to your prescriber and watch for signs of infection. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Abatacept and Infliximab 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 Infliximab interaction managed?
What your care team typically does: Generally avoids using abatacept and infliximab (or other TNF blockers) at the same time, since combining them raises infection risk without extra benefit. When switching you from a TNF blocker like infliximab over to abatacept, they will monitor you more closely for signs of infection. What you should do: Keep taking your medicines exactly as prescribed and do… 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 Infliximab 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 Abatacept
Keep reading about Infliximab
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist