of dengue vaccine by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine.denosumabMonitor Closely (1)abatacept, denosumab. Other (see comment). Use Caution/Monitor. Comment: Caution should be taken in patients on concomitant immunosuppressants or with impaired immune systems because of increased risk for serious infections.etanerceptSerious - Use Alternative (1)abatacept, etanercept. Mechanism: pharmacodynamic synergism. Contraindicated. Increased risk of serious infection.fingolimodMonitor Closely (1)abatacept increases effects of fingolimod by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Concomitant therapy is expected to increase the risk of immunosuppression. Use caution when switching patients from long-acting therapies with immune effects. .hydroxyureaMonitor Closely (1)hydroxyurea, abatacept. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of immunosuppression.idecabtagene vicleucelSerious - Use Alternative (1)abatacept, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.infliximabSerious - Use Alternative (1)abatacept, infliximab. Mechanism: pharmacodynamic synergism. Contraindicated. Increased risk of serious infection.influenza virus vaccine quadrivalent, adjuvantedSerious - Use Alternative (1)abatacept decreases effects of influenza virus vaccine quadrivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.influenza virus vaccine trivalent, adjuvantedSerious - Use Alternative (1)abatacept decreases effects of influenza virus vaccine trivalent, adjuvanted by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressive drugs may reduce the immune response to influenza vaccine.isavuconazonium sulfateMonitor Closely (1)abatacept and isavuconazonium sulfate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor.lisocabtagene maraleucelSerious - Use Alternative (1)abatacept, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.meningococcal group B vaccineMonitor Closely (1)abatacept decreases effects of meningococcal group B vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Individuals with altered immunocompetence may have reduced immune responses to the vaccine.ocrelizumabMonitor Closely (1)abatacept and ocrelizumab both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration of ocrelizumab with immunosuppessants is expected to increase the risk of immunosuppression.ofatumumab SCMonitor Closely (1)ofatumumab SC, abatacept. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. When switching from therapies with immune effects, take into account the duration and mechanism of action of these therapies when initiating ofatumumab SC.olaparibMonitor Closely (1)abatacept and olaparib both increase pharmacodynamic synergism. Use Caution/Monitor. Coadministration with other other myelosuppressive anticancer agents, including DNA damaging agents, may potentiate and prolongate the myelosuppressive toxicity. ozanimodMonitor Closely (1)ozanimod, abatacept. Either increases effects of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Coadministration with immunosuppressive therapies may increase the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs in order to avoid unintended additive immunosuppressive effects.ponesimodMonitor Closely (1)ponesimod and abatacept both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.rozanolixizumabMonitor Closely (1)abatacept will decrease the level or effect of rozanolixizumab by plasma protein binding competition. Use Caution/Monitor. Rozanolixizumab may lower systemic exposures and reduce effectiveness of medications that bind to the human neonatal Fc receptor (FcRn). Closely monitor for decreased efficacy of such medications. When long-term use of such medications is required, consider discontinuing rozanolixizumab and using alternative therapies.siponimodMonitor Closely (1)siponimod and abatacept both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects.sipuleucel-TMonitor Closely (1)abatacept decreases effects of sipuleucel-T by pharmacodynamic antagonism. Modify Therapy/Monitor Closely.tisagenlecleucelSerious - Use Alternative (1)abatacept, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.tocilizumabSerious - Use Alternative (1)abatacept, tocilizumab. Mechanism: unspecified interaction mechanism. Contraindicated. Concomitant use not recommended (in mfr. info.).tofacitinibSerious - Use Alternative (1)abatacept, tofacitinib. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.trastuzumabMonitor Closely (1)trastuzumab, abatacept. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .trastuzumab deruxtecanMonitor Closely (1)trastuzumab deruxtecan, abatacept. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Use Caution/Monitor. Neutropenia or febrile neutropenia incidence were increased when trastuzumab was coadministered with myelosuppressive chemotherapy. .ublituximabMonitor Closely (1)ublituximab and abatacept both increase immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Owing to potential additive immunosuppressive effects, consider duration of effect and mechanism of action of these therapies if coadministeredupadacitinibContraindicated (1)abatacept, upadacitinib. Either increases effects of the other by immunosuppressive effects; risk of infection. Contraindicated. >10% Headache (18%) Nasopharyngitis (12%) Nausea (>10%) Infection (54% for adults & 36% for children) 1-10% Dizziness (9%) Cough (8%) Back pain (7%) Hypertension (7%) Dyspepsia (6%) Urinary Tract Infection (6%) Rash (4%) Pain in extremety (3%) < 1% Acute lymphocytic leukemia Anaphylaxis Cellulitis COPD exacerbation Disease flare Diverticulitis Dyspnea Flushing Hypersensitivity Hypotension Joint wear Lung cancer Lymphoma Malignancies Ovarian cyst Pruitus Pyelonephritis Rhonchi Urticaria Varicella infection Wheezing Frequency Not Defined Nausea Abdominal pain Diarrhea Postmarketing Reports New or worsening psoriasis Contraindications None listed by the manufacturer Cautions Appropriate medical support measures for treatment of hypersensitivity reactions should be available for immediate use in event of reaction; if an anaphylactic or other serious allergic reaction occurs, stop administration immediately; institute appropriate therapy; permanently discontinue therapy Higher risk for serious infections; concomitant use with a TNF antagonist can also increase risk of infections and serious infections; concurrent therapy with another TNF antagonist not recommended; discontinue if serious infections develop Serious infections, including sepsis and pneumonia, reported; some of these infections have been fatal; many of the serious infections have occurred in patients on concomitant immunosuppressive therapy which in addition to their underlying disease, could further predispose them to infection; a higher rate of serious infections has been observed in adult RA patients treated with concurrent TNF antagonists Healthcare providers should exercise caution when considering therapy in patients with a history of recurrent infections, underlying conditions which may predispose them to infections, or chronic, latent, or localized infections; patients who develop a new infection while undergoing treatment should be monitored closely; administration should be discontinued if a patient develops a serious infection Antirheumatic therapies have been associated with hepatitis B reactivation; screening for viral hepatitis should be performed in accordance with published guidelines before starting therapy Prior to initiating therapy, patients should be screened for latent tuberculosis (TB) infection with a tuberculin skin test; therapy has not been studied in patients with a positive TB screen; safety of therapy in individuals with latent TB infection is unknown; patients testing positive in TB screening should be treated by standard medical practice prior to therapy Prior to initiating therapy, update vaccinations in accordance with current vaccination guidelines; treated patients may receive current non-live vaccines; live vaccines should not be given concurrently or within 3 months after discontinuation; no data are available on secondary transmission of infection from persons receiving live vaccines to patients receiving therapy; based on mechanism of action, therapy may blunt effectiveness of some immunizations Increased risk of lymphoma and lung cancer reported; significance unknown; increased risk of lymphoma associated with rheumatoid arthritis Patients receiving therapy for RA reported to develop adverse events more frequently, including COPD exacerbations, cough, rhonchi, and dyspnea; therapy in patients with COPD should be undertaken with caution and such patients should be monitored for worsening of their respiratory status The possibility exists for drugs inhibiting T cell activation, to affect host defenses against infections and malignancies since T cells mediate cellular immune responses; there have been reports of malignancies, including skin cancer in patients receiving therapy; periodic skin examinations are recommended for all treated patients, particularly those with risk factors for skin cancer Higher incidence of infections and malignancy reported in the elderly; use caution Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) reactivation CMV and EBV reactivation reported in aGVHD prophylaxis after hematopoietic cell transplant (HSCT) Post-transplant lymphoproliferative disorder (PTLD) occurred in patients who received drug for aGVHD prophylaxis during unrelated HSCT; all the PTLD events were associated with Epstein-Barr virus (EBV) infection; monitor patients for EBV reactivation in accordance with institutional practices; provide prophylaxis for EBV infection for 6 months post-transplantation to prevent EBV-associated PTLD Cytomegalovirus (CMV) invasive disease reported in patients who received therapy for aGVHD prophylaxis during unrelated HSCT; monitor patients for CMV infection/reactivation for 6 months post-transplant regardless of results of donor and recipient pre-transplant CMV serology; consider prophylaxis for CMV infection/reactivation Pregnancy There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to therapy during pregnancy; healthcare professionals are encouraged to register patients and pregnant women are encouraged to enroll themselves by calling 1-877-311-8972 There are no adequate and well-controlled studies of use in pregnant women; data in pregnant women are insufficient to inform on drug-associated risk; however, there are clinical considerations for administering live vaccines to infants exposed to the drug while in utero In reproductive toxicology studies in rats and rabbits, no fetal malformations were observed with intravenous administration during organogenesis at doses that produced exposures approximately 29 times the exposure at the maximum recommended human dose (MRHD) of 10 mg/kg/month on an AUC basis; however, in a pre-and postnatal development study in rats, therapy altered immune function in female rats at 11 times the MRHD on an AUC basis It is unknown if abatacept can cross the placenta into the fetus when a woman is treated during pregnancy; the drug is an immunomodulatory agent; it is unknown if immune response of an infant who was exposed in utero to abatacept and subsequently administered a live vaccine is impacted; risks and benefits should be considered prior to vaccinating such infants Lactation There is no information regarding presence of abatacept in human milk, effects on breastfed infant, or effects on milk production; however, abatacept was present in the milk of lactating rats dosed with abatacept.Pregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Chimeric protein that inhibits T-lymphocyte activation Pharmacokinetics Half-life, Terminal: 13 days Peak Plasma: 295 mcg/mL Vd: 0.07 L/kg Clearance: 0.22 mL/hr/kg IV Compatibility 0.9% NaCl IV Preparation Reconstitution Reconstitute each vial contents with 10 mL sterile water for injection using ONLY the silicone-free disposable syringe supplied to obtain a 25 mg/mL solution If lyophilized powder is accidently reconstituted using a siliconized syringe, solution may develop a few translucent particles (discard any solutions prepared using siliconized syringes If silicone-free disposable syringe is dropped or becomes contaminated, use a new silicone-free disposable syringe; obtain new silicone-free syringes, contact BristolMyers Squibb at 1-800-ORENCIA Gently swirl vial to minimize foam formation, until contents are completely dissolved; do not shake; avoid prolonged or vigorous agitation Once completely dissolve, vent vial with a needle to dissipate any foam that may be present Visually inspect the reconstituted solution (the solution should be clear and colorless to pale yellow); discard if opaque particles, discoloration, or other foreign particles are present Dilution Withdraw volume of 0.9% NaCl equal to calculated dose volume; final concentration of infusion ≤10 mg/mL Slowly add reconstituted solution from each vial into the infusion bag or bottle using the same disposable syringe Gently mix; avoid shaking infusion bag or bottle Discard any unused portion immediately Do not use if any discoloration or particulate matter present IV Administration Infuse with a sterile, nonpyrogenic,