Tocilizumab and Abatacept Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 10, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Abatacept Injection
Tocilizumab
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.
What happens
An increased risk of infection
Interaction Deep Dive
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 infection1.
Why it happens (mechanism)
Unknown
Literature reports
2 reports — tap to read
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 1.
Common questions
Can I take Tocilizumab and Abatacept Injection together?
An increased risk of infection Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tocilizumab and Abatacept Injection 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 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 Tocilizumab or Abatacept Injection 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 Injection
Keep reading about Tocilizumab
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