Can you take Orencia (abatacept) and Humira (adalimumab) together?

Concurrent Use of Orencia (Abatacept) and Humira (Adalimumab) is Not Recommended

Concurrent use of Orencia (abatacept) and Humira (adalimumab) is contraindicated due to increased risk of serious infections without added clinical benefit. 1

Rationale for Avoiding Combination

The FDA drug label for Humira (adalimumab) explicitly states that the combination of TNF-blockers (like adalimumab) with abatacept is associated with:

• Greater proportion of serious infections compared to TNF-blocker use alone
• No demonstrated improved clinical benefit in treatment outcomes
• The combination is specifically not recommended 1

Evidence Supporting This Recommendation

Safety Concerns

The combination therapy presents significant safety risks:

• Increased risk of serious infections is the primary concern when combining these biologics 1
• The FDA label specifically highlights this combination as problematic in section 5.11 of the Humira prescribing information 1
• In controlled trials, concurrent administration of TNF-blockers and abatacept showed higher infection rates without improved clinical benefit 1

Comparative Efficacy as Monotherapies

If choosing between these agents:

• The AMPLE trial, a head-to-head comparison over 2 years, found subcutaneous abatacept and adalimumab had similar efficacy outcomes when each was combined with methotrexate 2
• At 2 years, ACR20/50/70 responses were comparable: 59.7%/44.7%/31.1% for abatacept and 60.1%/46.6%/29.3% for adalimumab 2
• Abatacept showed fewer discontinuations due to adverse events (3.8% vs 9.5%), serious adverse events (1.6% vs 4.9%), and serious infections (0/12 vs 9/19 patients) compared to adalimumab 2

Alternative Approaches

Instead of combining these medications, consider:

1. Sequential monotherapy: Try one biologic agent first, and if inadequate response, switch to the other
2. Combination with methotrexate: Both agents have demonstrated efficacy when combined with methotrexate 2
3. Consider patient-specific factors: Choose between abatacept or adalimumab based on:
   • Infection risk profile (abatacept may have lower serious infection risk) 2
   • Comorbidities (especially history of serious infections) 3
   • Age (older patients have higher infection risk with biologics) 3

Important Monitoring Considerations

If using either medication as monotherapy:

• Screen for tuberculosis and hepatitis B before initiating therapy
• Monitor for signs of infection during treatment
• Be vigilant for injection site reactions (less common with abatacept than adalimumab - 4.1% vs 10.4%) 2
• Watch for serious adverse events including autoimmunity and hematologic abnormalities 1, 4

Conclusion

The combination of Orencia (abatacept) and Humira (adalimumab) should be avoided due to increased infection risk without added clinical benefit. Each medication can be effective as monotherapy or in combination with methotrexate, but they should not be used concurrently.