Orencia: Self-Injected Biologic for RA

Orencia was released recently as the first biologic drug in its class with FDA approval for self-injection, alleviating the need for monthly visits to the doctor or infusion center to get the medication.

Early use of disease modifying therapy for rheumatoid arthritis has become the standard of care for moderate to severe cases of rheumatoid arthritis, and multiple new drugs have become available over the last decade or so to use to prevent the development and progression of pain, deformity and disability from the bone erosions, joint swelling and sequelae of RA.  Except for oral methotrexate, all of the previously available treatments involved visiting a doctor’s office or infusion center to get IV infusions of these medications, but not Orencia has been FDA approved for patient self-injection.

Orencia, generic name abatacept, works by altering T-cell activity, and is among the type of drugs known as biological treatments. Orencia was previously available as an intravenous infusion, and now can be used by patients with a subcutaneous self-injection.  Patients have long done self injection for drugs that can be injected subcutaneously with insulin being the most common drug used in this way. Having a self-injected biological drug for RA will allow patients to receive this type of therapy when monthly visits to their rheumatologist are impractical or inconvenient. Patients living in rural areas, for whom mobility is an issue, or for whom missing work is difficult may find Orencia self-injection a nice option.

Rheumatoid arthritis therapy has evolved tremendously in the last 30 years.  For decades treatment of pain with aspirin or later with other NSAIDS like ibuprofen and others was the mainstay of therapy. In cases where more intensive therapy was needed long-term corticosteroid therapy was used, with the often miserable and serious prednisone side effects including iatrogenic Cushing’s Syndrome and adrenal suppression. Methotrexate was the first of the disease altering drugs to become understood and widely used, but methotrexate side effects including cirrhosis of the liver, bone marrow suppression, and others can limit use of methotrexate in many.  For others methotrexate alone does not give adequate control of the progression of RA.

If first line treatment with methotrexate is not giving adequate disease control, usually the second line of therapy is with one of several biologic drugs called anti-tumor necrosis factor (anti-TNF) drugs.  Examples of anti-TNF drugs are Remicaide®, Humira®, Cimzia®, Simponi® and Enbrel®.  If one or more of these second line therapy options is not tolerated or ineffective then a third line drug is usually used.  Orencia is currently considered among other options as a third line option for RA treatment. The availability of Orencia as a self-injected medication may make it attractive enough in select cases to make it an option ahead of the second line anti-TNF drugs. Like the anti-TNF drugs Orencia is often used in conjunction with methotrexate, but cannot be used in conjunction with other biological treatments like the anti-TNF biological drugs.

Orencia side effects are common and potentially serious. Common Orencia side effects include headache, hypertension, fever, rash and serious infections among others.  More serious Orencia side effects can be vasculitis, multiple sclerosis, and many types of serious or even life threatening infections.

 

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