How Orencia (Abatacept) Works

In February 2018, we started a series on how specific biologic medications work. Rituxan was the first medication presented. This was prompted by a patient asking me to express in writing what I verbally explain when someone is starting this medication.

Today we are featuring Orencia, also known as abatacept.  This medication is approved for rheumatoid arthritis.  Within our immune system are dendritic cells.  Their job is to survey the body and report any irregular cells or invaders; such as a virus or bacteria. Unfortunately, in rheumatoid arthritis, these cells generate an alert to the immune system that results in excess inflammation being made within joints; when there is no virus or bacteria present.  The goal of Orencia is to block the signalling from the dendritic cells to prevent excess inflammation from being produced.  Unlike other biologic medications, which trap and remove specific inflammatory substances, Orencia works to prevent excess inflammation from being produced in the first place.

As with all biologic medication, Orencia is composed of protein and therefore it cannot be swallowed or it would be digested in the stomach and destroyed. There is an option of receiving a weekly injectable form of this medication or an infusion that is given monthly after the loading dose at week 0, 2, and 4.  The goal of all biologic medication for rheumatoid arthritis is to achieve a level of low disease activity or remission.

All biologics used in autoimmune conditions have a risk of infection, which is a little greater than in the general public, and therefore updating adult vaccines is suggested.  This treatment is not given when a person is experiencing an active infection.  Orencia has been used safely in many patients with pre-existing medical conditions such as kidney and liver disease.


Carolyn Whiskin is the Pharmacy Manager for Charlton Health.  Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

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