Abatacept Disease Interactions

In studies, patients with chronic obstructive pulmonary disease (COPD) treated with abatacept for rheumatoid arthritis developed adverse events (including COPD exacerbations, cough, rhonchi, dyspnea) more frequently than those treated with placebo. Abatacept should be used with caution in patients with COPD and such patients should be monitored for worsening of their respiratory status.

Parenteral drug products containing maltose can interfere with readings from blood glucose monitors that use test strips with glucose dehydrogenase pyrroloquinoline quinone (GDH-PQQ). The GDH-PQQ-based glucose monitoring systems may react with the maltose in abatacept for IV administration, resulting in falsely elevated blood glucose readings on the day of abatacept infusion. When receiving IV abatacept, patients that require blood glucose monitoring should be advised to consider methods that do not react with maltose, such as those based on glucose dehydrogenase nicotine adenine dinucleotide (GDH-NAD), glucose oxidase, or glucose hexokinase test methods.

Because abatacept for subcutaneous administration does not contain maltose, patients do not need to alter their glucose monitoring.

Because antirheumatic therapies have been associated with hepatitis B reactivation, patients should be screened for viral hepatitis in accordance with published guidelines before starting therapy with abatacept. Patients screening positive for hepatitis were excluded from clinical studies with abatacept.

Serious infections (including sepsis, pneumonia) have been reported in patients receiving abatacept. Caution and close monitoring are recommended when considering the use of abatacept in patients with history of recurrent infections, underlying conditions which may predispose them to infections, or chronic, latent, or localized infections. Administration of abatacept should be discontinued if a patient develops a serious infection.

Posttransplant lymphoproliferative disorder (PTLD) and cytomegalovirus (CMV) invasive disease occurred in patients who received abatacept for acute graft versus host disease (aGVHD) prophylaxis during unrelated hematopoietic stem cell transplantation (HSCT); the PTLD events were associated with Epstein-Barr virus (EBV) infection. Patients should be monitored for EBV reactivation according to institutional practices; prophylaxis for EBV infection should be provided for 6 months posttransplantation to prevent EBV-associated PTLD. Patients should be monitored for CMV infection/reactivation for 6 months posttransplant regardless of pretransplant CMV serology results for donor and recipient; prophylaxis for CMV infection/reactivation should be considered.

Prior to initiating abatacept, patients should be screened for latent tuberculosis infection with a tuberculin skin test. Patients testing positive in tuberculosis screening should be treated by standard medical practice prior to therapy with abatacept. Caution should be taken when prescribing abatacept to these patients as this agent has not been studied in patients with a positive tuberculosis screen, and the safety of abatacept in patients with latent tuberculosis infection is unknown.