Abatacept and Risankizumab: 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
Risankizumab
No brand names on record
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 of these medicines calm down your immune system, but they work in different ways. Abatacept (Orencia) and risankizumab are both biologic drugs used for conditions like arthritis or psoriasis. When you take two immune-lowering medicines together, your body can have a harder time fighting off germs, so there is a higher chance of getting a serious infection.
The good news is that this is something your care team watches for. In fact, doctors usually do not recommend using two biologics like these at the same time. Please don't stop or change anything on your own. Talk with your doctor or pharmacist so they can pick the safest plan for you.
Effect: Additive immunosuppression increasing the risk of serious infection.
Mechanism: Unknown/theoretical for this specific pair. Both are biologic immunomodulators (abatacept is a selective T-cell costimulation modulator; risankizumab is an IL-23 inhibitor). Neither is a prodrug; this is a pharmacodynamic, not pharmacokinetic, interaction.
Evidence: Theoretical, extrapolated from controlled trials showing increased serious infection and no added benefit when abatacept was combined with TNF antagonists.
- Concurrent use of abatacept with other RA/PsA biologics is not recommended.
- If transitioning off one agent, monitor closely for signs of infection.
- Severity: major; onset unspecified.
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 extra therapeutic benefit. Data are inadequate to assess how safe and effective abatacept is when combined with anakinra or with biologic agents used for rheumatoid arthritis or psoriatic arthritis. For this reason, using these drugs at the same time is not advised. Patients who are being switched from TNF antagonist therapy to abatacept should be watched for indications of infection1.
Why it happens (mechanism)
Unknown
How to manage this interaction
What your care team typically does:
- Combining abatacept with another biologic like risankizumab is generally not recommended, so your team will usually choose one agent rather than using both together.
- If you are switching from one biologic to abatacept (or the reverse), your team may monitor you more closely for signs of infection during the transition.
What you should do:
- Keep taking your medicines exactly as prescribed unless told otherwise.
- Tell your prescriber or pharmacist if you are on both, and report fever, chills, cough, or any sign of infection right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) Taking abatacept together with etanercept provided no extra efficacy but raised the risk of serious infection when compared with etanercept used on its own. In a 1-year randomized study (N=121) that was 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 that 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 portion, patients were eligible for the LTE phase, at which point the abatacept dose was raised to roughly 10 mg/kg. At 6 months, the 2 mg/kg abatacept group demonstrated no significant improvement versus 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%). Serious infections at 1 year 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 by itself (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 therapy; furthermore, the combined therapy offered no additional benefit 1.
Common questions
Can I take Abatacept and Risankizumab together?
Using abatacept and risankizumab together can raise your risk of serious infection, and this combination is generally not recommended. Talk with your doctor or pharmacist so they can choose the safest single therapy and watch you for infection. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Abatacept and Risankizumab 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 Risankizumab interaction managed?
What your care team typically does: Combining abatacept with another biologic like risankizumab is generally not recommended, so your team will usually choose one agent rather than using both together. If you are switching from one biologic to abatacept (or the reverse), your team may monitor you more closely for signs of infection during the transition. What you should do: Keep taking your medici… 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 Risankizumab 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 Risankizumab
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