Orencia (Abatacept) Subcutaneous Injection Dosing
For subcutaneous Orencia (abatacept), the loading dose is 125 mg administered once, followed by a maintenance dose of 125 mg administered once weekly. 1
Dosing Details
Loading Dose Options
- Standard subcutaneous loading dose: 125 mg administered subcutaneously
- Optional intravenous loading dose: May be administered before starting subcutaneous injections, based on body weight:
- Less than 60 kg: 500 mg IV (2 vials)
- 60 to 100 kg: 750 mg IV (3 vials)
- More than 100 kg: 1,000 mg IV (4 vials)
Maintenance Dose
- 125 mg administered subcutaneously once weekly
Timing Between Loading and Maintenance Doses
- If using subcutaneous loading dose: Begin weekly maintenance doses immediately after loading dose
- If using optional IV loading dose: Administer first subcutaneous maintenance dose within one day of the IV infusion
Administration Considerations
Switching from IV to Subcutaneous Administration
- For patients transitioning from intravenous Orencia to subcutaneous administration, administer the first subcutaneous dose instead of the next scheduled intravenous dose 1
Injection Technique
- Subcutaneous injections are administered using either:
- Prefilled syringes (125 mg)
- ClickJect™ autoinjector (125 mg)
Tolerability
- Subcutaneous abatacept is generally well-tolerated with minimal injection site reactions
- In clinical trials, only 2% of patients experienced injection site reactions, with almost all being mild in intensity 2
Special Populations
Pediatric Patients (2 years and older)
- Weight-based dosing applies:
- 10 to less than 25 kg: 50 mg once weekly
- 25 to less than 50 kg: 87.5 mg once weekly
- 50 kg or more: 125 mg once weekly 1
Renal Impairment
- No dose adjustment required for subcutaneous administration in patients with renal impairment
Clinical Efficacy and Safety
- Long-term studies show sustained efficacy with subcutaneous abatacept administration
- The ACQUIRE trial demonstrated comparable efficacy between subcutaneous and intravenous administration routes 2
- Immunogenicity rates are low (approximately 4%) and typically transient, regardless of whether methotrexate is used concomitantly 3
Important Considerations
- Ensure proper storage of prefilled syringes or autoinjectors (refrigerated at 2°C to 8°C)
- Allow medication to reach room temperature (30-60 minutes) before injection
- Rotate injection sites to prevent tissue damage
- No maximum volume limitations for subcutaneous administration of abatacept as each injection is 1 mL
Remember that consistent weekly administration is important for maintaining therapeutic levels and optimal clinical response.