Orencia is the brand name of abatacept, a prescription medication used to treat certain autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis, and juvenile idiopathic arthritis. It is classified as a biologic medication, which means it is made from biological sources and works by targeting specific proteins in the body to help regulate the immune system and reduce inflammation. (Source)

Orencia is not a cure for autoimmune diseases, but it can help improve symptoms and slow disease progression. As with other medications, Orencia has the potential to cause side effects ranging from mild to severe, and may not be appropriate for everyone. In this article we’ll look at how abatacept works and its potential side effects, as well as other medications and diet and lifestyle changes that may be alternatives to abatacept.

How Does Abatacept Work?

Abatacept works by blocking a molecule called CD28 from binding with receptors found on immune cells called T lymphocytes, or T-cells for short. T-cells are involved in activating an immune response when they identify foreign invaders, like viruses and bacteria. With autoimmune conditions, however, this immune response can mistakenly cause an attack on healthy tissues.

By keeping CD28 from binding with its receptors, abatacept prevents T-cells from triggering a chain of events involving other immune cells. This, in turn, helps reduce the over-activation of the immune system and the inflammation that occurs in autoimmune conditions. By slowing down the immune response in this way, abatacept helps to improve symptoms of autoimmune conditions such as joint pain, swelling, and stiffness. (Source, Source, Source, Source)

It is important to note that abatacept does not completely suppress the immune system, as some other medications used to treat autoimmune conditions do. Instead, it targets a specific part of the immune response, which can help to reduce inflammation while still allowing the immune system to function normally in other ways.

Abatacept may be prescribed alone or in combination with other medications such as methotrexate or corticosteroids to provide the best possible outcome for people with autoimmune conditions. It is given as an injection or intravenous infusion, and the dosage and frequency of treatment will depend on the individual's condition and response to the medication. It can be self-administered at home or given by a health care provider in a clinical setting. (Source, Source)

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What Autoimmune Conditions Does Orencia (Abatacept) Treat?

The U.S. Food and Drug Administration (FDA) has approved Orencia for treating several autoimmune conditions, but it’s sometimes prescribed for other conditions, which is known as “off-label” use.

• rheumatoid arthritis: Orencia is FDA-approved to treat adults with moderate to severe rheumatoid arthritis, a chronic inflammatory disease that affects the joints and other parts of the body, causing pain, swelling, and stiffness.
• psoriatic arthritis: Orencia is FDA-approved to treat adults with active psoriatic arthritis, a chronic inflammatory disease that affects the joints and skin, causing joint pain, swelling, and skin lesions.
• juvenile idiopathic arthritis: Orencia is FDA-approved to treat children ages 2 and older with moderate to severe polyarticular juvenile idiopathic arthritis, a type of arthritis that affects children and causes joint pain, swelling, and stiffness.
• systemic lupus erythematosus: Orencia is not FDA-approved to treat systemic lupus erythematosus, a chronic autoimmune disease that can affect many parts of the body, causing joint pain, skin rashes, and other symptoms, but it may be used off-label in some cases.
• Sjogren’s syndrome: Orencia is not FDA-approved to treat Sjogren’s syndrome, an autoimmune disorder that affects the glands that produce moisture, causing dry eyes and mouth, but it may be used off-label in some cases.

(Source, Source, Source, Source, Source)

What Are the Possible Side Effects of Orencia?

Like all medications, Orencia can cause side effects, ranging from mild to severe. It is important to note that not everyone will experience these side effects, and some people may experience effects other than those listed here. If you are taking Orencia and experience any new or concerning symptoms, it is important to talk to your health care provider right away.

Common Side Effects 

Some of the most common side effects of Orencia include:

• injection site reactions, including pain, swelling, itching, and redness
• headaches, which are usually mild and go away on their own
• upper respiratory tract infections, such as head colds
• nausea and vomiting
• dizziness
• sore throat
• hypertension

(Source, Source)

Severe Side Effects

In rare cases Orencia can cause more serious side effects, including:

• serious infections: Orencia may increase the risk of serious infections, including tuberculosis and fungal infections. It’s important to let your health care provider know if you have a history of infections or if you develop any signs of infection, such as fever, chills, cough, or shortness of breath, while taking Orencia.
• allergic reactions: Orencia can cause severe allergic reactions, including anaphylaxis, which is a life-threatening reaction that can cause difficulty breathing, hives, and swelling of the face, tongue, or throat.
• hepatitis B reactivation: Orencia may cause the reactivation of hepatitis B infection in people with the virus. Your health care provider may test you for hepatitis B before starting Orencia and monitor you for signs of reactivation during treatment.
• cancer: While the risk is low, Orencia has been associated with an increased risk of certain types of cancer, such as lymphoma and skin cancer. It isn’t clear if Orencia increases the risk of cancer, but it is important to let your health care provider know if you have a history of cancer or develop any new symptoms.
• autoimmune reactions: In rare cases, Orencia can cause autoimmune reactions, which occur when the immune system attacks healthy tissues in the body. This can cause symptoms such as joint pain, fever, and rash. 

(Source, Source, Source, Source, Source)

What Supplements or Other Drugs Interact with Orencia?

Orencia, like many medications, can interact with other drugs and supplements, so be sure to inform your health care provider of all the medications and supplements you are currently taking. Contraindications include:

• live vaccines: Avoid live vaccines, such as those for measles, mumps, rubella (MMR), rotavirus, and yellow fever, while taking Orencia. Live vaccines contain weakened versions of bacteria and viruses that cause disease in their natural form; because abatacept reduces your immune response, you could be at risk for infection from a live vaccine. 
• immunosuppressants: Combining Orencia with other medications that suppress the immune system, or other biologic medications used to treat autoimmune diseases, may increase the risk of serious infections and other side effects. Immunosuppressive drugs include azathioprine, cyclosporine, and TNF inhibitors (such as adalimumab, etanercept, and infliximab). TNF inhibitors may also decrease Orencia’s effectiveness. 
• NSAIDs and corticosteroids: While Orencia can be taken in combination with nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen) or corticosteroids (such as prednisone), it is crucial to monitor for potential side effects and adjust the dosage as needed. These medications can increase the risk of gastrointestinal issues, such as stomach ulcers and bleeding, when taken together.

(Source, Source, Source)

Orencia Alternatives

While Orencia may be an effective treatment option for autoimmune diseases, it may not be the best option for everyone. Dietary and lifestyle changes can also be helpful in reducing inflammation and improving overall health. Additionally, there are other medications that can be considered when treating autoimmune conditions.

Dietary Changes 

Changing your diet can help reduce inflammation in your body, which can in turn help improve symptoms of autoimmune diseases commonly treated by Orencia.

• An anti-inflammatory diet is rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. This type of diet can help reduce inflammation and may improve symptoms of autoimmune diseases. Foods to include in an anti-inflammatory diet include berries, leafy greens, nuts, fatty fish, and olive oil. (Source)
• An elimination diet, such as the autoimmune protocol (AIP), involves removing certain foods from your diet to see if they are causing inflammation or triggering symptoms of autoimmune disease. Common foods that may be eliminated include dairy, gluten, soy, and processed foods. Once a trigger food is identified, it can be eliminated from your diet to help reduce inflammation and improve symptoms. (Source)
• Decrease, limit, or eliminate caffeine and alcohol, as both can be inflammatory. Alcohol can also be an immunosuppressant. (Source, Source, Source)
• Certain supplements may also be helpful in reducing inflammation and improving symptoms of autoimmune diseases. Omega-3 fatty acids, vitamin D, and probiotics are all supplements that have been shown to have anti-inflammatory properties and are included in our list of the best supplements for rheumatoid arthritis. (Source)

Lifestyles Changes 

Various lifestyle changes can also be helpful in reducing inflammation and improving overall health. 

• Regular exercise can help reduce inflammation and improve symptoms of autoimmune diseases. Low-impact exercises such as yoga, swimming, and cycling may be best for people with joint pain from conditions such as rheumatoid arthritis. (Source)
• Stress can trigger inflammation in the body, so reducing stress can be an important part of managing autoimmune disease. Meditation, deep breathing exercises, and regular massages are a few examples of stress-reducing activities that may be helpful. There are also many foods that have been shown to help lower your levels of cortisol, the “stress hormone.” (Source, Source, Source)
• Getting enough sleep is important for overall health, and can also help decrease stress, reduce inflammation, and improve symptoms of autoimmune diseases. Create a relaxing bedtime routine that helps you fall asleep more easily, and aim for 7 to 8 hours of restful sleep per night. (Source)
• Certain environmental factors can trigger symptoms of autoimmune diseases. For example, exposure to cold temperatures may trigger joint pain in people with rheumatoid arthritis. Identifying and avoiding these triggers can help reduce inflammation and improve symptoms. (Source)
• Maintain and foster social connections. Healthy relationships can positively affect your health in various ways, such as reducing stress levels, increasing happiness, boosting your immune system, and promoting healthy habits. Cultivating strong, stable relationships can promote overall well-being and help to combat autoimmune symptoms. (Source, Source)

Medication Alternatives to Orencia

There are several other medications that are also used to treat similar autoimmune diseases and may be prescribed instead of Orencia.

• tumor necrosis factor (TNF) inhibitors such as adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade). Like Orencia, TNF inhibitors work to reduce inflammation and slow down disease progression in autoimmune diseases. (Source)
• interleukin inhibitors such as tocilizumab (Actemra) and anakinra (Kineret). These medications target specific interleukins, which are proteins that play a role in inflammation and immune system function. (Source, Source)
• Janus kinase (JAK) inhibitors such as tofacitinib (Xeljanz) and baricitinib (Olumiant). JAK inhibitors work by blocking certain enzymes involved in the immune response, which helps to reduce inflammation and slow disease progression. (Source, Source)
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve). NSAIDs work to relieve pain and reduce inflammation, but they do not slow down disease progression of autoimmune diseases. (Source)
• disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and sulfasalazine. DMARDs work to slow down disease progression in autoimmune diseases, but they may take longer to work than biologic medications like Orencia. (Source, Source, Source)

The Bottom Line on Orencia Side Effects

Orencia (abatacept) is a biologic that can be an effective treatment option for several autoimmune conditions such as rheumatoid arthritis, psoriatic arthritis, and juvenile idiopathic arthritis. While it can cause side effects, most people are able to take Orencia safely and experience significant improvements in their symptoms. If you are considering taking Orencia or are already taking the medication, it is important to talk to your health care provider about the potential benefits and risks.

WellTheory’s Care Team can help you weigh the pros and cons of Orencia. Our goal is to identify the root causes of your symptoms and develop a personalized treatment plan that is right for you. By promoting holistic lifestyle habits in diet, sleep, physical activity, and stress management, our Care Team can help regain control over your health.