BNF for Children 2011-2012

510 10.1.3 Drugs that suppress the rheumatic disease process BNFC 2011–201210 Musculoskeletal and joint diseasesABATACEPTCautions predisposition to infection (screen for latenttuberculosis and viral hepatitis); do not initiate untilactive infections are controlled; children should bebrought up to date with current immunisation schedule(section 14.1) before initiating therapy; progressivemultifocal leucoencephalopathy—discontinuetreatment if neurological symptoms present; interactions:Appendix 1 (abatacept)Contra-indications severe infection (see also Cautions)Pregnancy manufacturer advises avoid unless essential—effectivecontraception required during treatmentand for 14 weeks after last doseBreast-feeding present in milk in animal studies—manufacturer advises avoid breast-feeding duringtreatment and for 14 weeks after last doseSide-effects abdominal pain, diarrhoea, dyspepsia,nausea; flushing, hypertension; cough; dizziness, fatigue,headache; infection, rhinitis; rash; less commonlygastritis, stomatitis, tachycardia, bradycardia, palpitation,hypotension, dyspnoea, paraesthesia, weightgain, depression, anxiety, amenorrhoea, basal cellcarcinoma, thrombocytopenia, leucopenia, arthralgia,pain in extremities, conjunctivitis, visual disturbance,vertigo, bruising, alopecia, and dry skinIndication and doseModerate to severe active polyarticular juvenileidiopathic arthritis (in combination withmethotrexate) in children who have notresponded adequately to other disease-modifyingantirheumatic drugs (including at leastone tumour necrosis factor (TNF) inhibitor). By intravenous infusionChild 6–17 yearsBody-weight less than 75 kg 10 mg/kg, repeated2 weeks and 4 weeks after initial infusion, thenevery 4 weeksBody-weight 75–100 kg 750 mg, repeated 2weeks and 4 weeks after initial infusion, then every4 weeksBody-weight over 100 kg 1 g, repeated 2 weeksand 4 weeks after initial infusion, then every 4weeksNote Review treatment if no response within 6 monthsAdministration for intravenous infusion, reconstituteeach vial with 10 mL water for injections using thesilicone-free syringe provided; dilute requisite dose inSodium Chloride 0.9% to 100 mL (using the samesilicone-free syringe); give over 30 minutes through alow protein-binding filter (pore size 0.2–1.2 micron)Orencia c (Bristol-Myers Squibb) TAIntravenous infusion, powder for reconstitution,abatacept, net price 250-mg vial = £242.17Electrolytes Na +