Ixekizumab and Abatacept: 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
Ixekizumab
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.
Abatacept (Orencia) and ixekizumab both calm down parts of your immune system. Abatacept dials back certain immune cells, and ixekizumab blocks an inflammation signal called IL-17. Each one helps with conditions like arthritis or psoriasis, but taking two of these immune-lowering biologics together can leave your body less able to fight off germs. That means a higher chance of serious infections, and studies haven't shown that combining them works better.
This is expected based on how these drugs work rather than proven with this exact pair. The good news: your care team knows how to handle this. Please don't change anything on your own, just talk with your doctor or pharmacist.
Effect: Additive immunosuppression, increasing risk of serious infection with no added therapeutic benefit.
- Mechanism: Unknown/pharmacodynamic. Abatacept (T-cell costimulation modulator) plus ixekizumab (IL-17A inhibitor) compound immune suppression. Neither is a prodrug; no CYP/transporter component.
- Direction: Increased infection risk (additive PD).
- Evidence: Theoretical; extrapolated from trials of abatacept with TNF antagonists and other RA/PsA biologics.
- Onset: Unspecified.
- Management: Concurrent use of abatacept with other RA/PsA biologics, including ixekizumab, is not recommended. If transitioning between agents, monitor closely for signs/symptoms of infection.
What happens
An increased risk of infection
Interaction Deep Dive
In controlled clinical trials, giving abatacept together with tumor necrosis factor (TNF) antagonists was shown to raise the risk of serious infection while offering no extra therapeutic 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 using these drugs concurrently is not advised. If therapy is being switched from a TNF antagonist to abatacept, patients should be watched for indications of infection1.
Why it happens (mechanism)
Unknown
How to manage this interaction
The main step here is avoiding routine use of these two biologics together. Guidance advises against combining abatacept with other biologics used for rheumatoid or psoriatic arthritis because of the higher infection risk without extra benefit.
- Keep taking your medications exactly as prescribed. Do not stop or start either one on your own.
- Tell your prescriber and pharmacist about every biologic you take so your regimen can be reviewed.
- If your team switches you from one to the other, they may monitor you more closely for signs of infection (fever, chills, cough, sores that won't heal).
- Report any signs of infection promptly.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) Taking abatacept together with etanercept produced no extra efficacy but raised the risk of serious infection when compared to etanercept used alone. In a 1-year randomized trial (N=121) that was followed by an open-label long-term extension (LTE; n=80), rheumatoid arthritis patients 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 finishing the double-blind portion, patients could enter the LTE phase, during which the abatacept dose was raised to about 10 mg/kg. At 6 months, the 2 mg/kg abatacept group demonstrated no meaningful 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 were found in ACR20, 50, or 70 response rates 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 following 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) versus TNF antagonist therapy on its own (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; in addition, the combined therapy offered no added benefit 1.
Common questions
Can I take Ixekizumab and Abatacept together?
Using abatacept and ixekizumab together raises your infection risk without added benefit, so combining these two biologics generally isn't recommended. Keep taking what you're prescribed and let your doctor or pharmacist review the combination. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ixekizumab and Abatacept 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 Ixekizumab and Abatacept interaction managed?
The main step here is avoiding routine use of these two biologics together. Guidance advises against combining abatacept with other biologics used for rheumatoid or psoriatic arthritis because of the higher infection risk without extra benefit. Keep taking your medications exactly as prescribed. Do not stop or start either one on your own. Tell your prescriber and pharmacist about every biologic y… 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 Ixekizumab or Abatacept 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 Ixekizumab
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