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Rheumatoid Arthritis. On Medication. Can I Increase The Dosage Of Abatacept By IV? Other Options?
Question: I am seeking an expert Rheumatologist on Abatacept (Orencia) For Rheumatoid Arthritis. I have been on this medication by IV for about 10 months. My dosage is 750mg every 4 weeks. My weight is 190. Even though my Physician is an excellent Rheumatologist, she has admittedly had limited experience with prescribing Abatacept. Which leads me to my question. Have you ever, or have you ever known of any Physician that has prescribed an INCREASE in the DOSAGE of Abatacept by IV. For example, I stated that I was receiving 750mg, and I feel that because it isn't doing quite as much as it should be doing, I would like the next highest increment which is 1000mg. I should also state that I am well aware that there are numerous other drug options. But rather than explore them at this time, I would first like to know that we gave this drug every chance before yet again, starting from square one.
Dear XXXXXXX,
For rheumatoid arthritis, 750 mg is the dose recommended for a person weighing between 6o and 100 kgs. (your weight).
I do not know any physician who has exceeded this dosage. The reason for this that dosage have been decided after extensive research. It is especially true for all biologicals (the category of medications under which abatacept falls) that beyond a certain dose they do not have any enhanced action.
It is also known that one biological may not be effective, but the other could have dramatic results in a the same patient. Hence, it is wiser to change the biological rather than escalate the dose. You may also predispose yourself to side effects if the dose is increased.
Hope your query is answered and write back if you have a follow up query.
Dr Praveen Jadhav
For rheumatoid arthritis, 750 mg is the dose recommended for a person weighing between 6o and 100 kgs. (your weight).
I do not know any physician who has exceeded this dosage. The reason for this that dosage have been decided after extensive research. It is especially true for all biologicals (the category of medications under which abatacept falls) that beyond a certain dose they do not have any enhanced action.
It is also known that one biological may not be effective, but the other could have dramatic results in a the same patient. Hence, it is wiser to change the biological rather than escalate the dose. You may also predispose yourself to side effects if the dose is increased.
Hope your query is answered and write back if you have a follow up query.
Dr Praveen Jadhav
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Well, since you are not aware of any Physician prescribing an increase in the dosage, what about a Physician that changes the frequency of the dosage? Perhaps every 3 weeks, versus every 4 weeks that I am prescribed now. It is true that the closer I get to infusion time, the more I seem to need the medication. As if it loses its kick before the 4 weeks is over.
Again, no luck here as well. No one will dare to cross the prescribed dosages, especially for newer medications like abatacept. This is more so for fear of legal implications just in case anything goes wrong.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr XXXXXXX
I promise this is my last question. What I can't understand is, if the dosage amount is all based on how much the patient weighs, then why does the person that weighs 199 get 750mg and the person that weighs only 2 pounds more (201) get 1000mg. Why, because the cut off is 200lbs for those that get the larger dosage. That being the case, how XXXXXXX can it be for me to only receive 750mg (I weigh 190) versus receiving 1000mg? The guy that weighs 10 pounds more gets 1000mg. Should I eat more to gain 10 more pounds? Technically because of my weight and the calculations on the Orencia web-site, I should be receiving 860mg, but it only comes in 3 sizes. 500, 750, & 1000mg. Taking into consideration all that information, in your opinion, wouldn't trying 1000mg at least be worth a try? Having had RA for 16 years, I am here to tell you that starting from square one with a new biologic YET AGAIN, isn't as easy as it sounds. (and being on prednisone for over a year!) Thank-you for your time and patience. PS I cannot tolerate Methotrexate or Arava
I promise this is my last question. What I can't understand is, if the dosage amount is all based on how much the patient weighs, then why does the person that weighs 199 get 750mg and the person that weighs only 2 pounds more (201) get 1000mg. Why, because the cut off is 200lbs for those that get the larger dosage. That being the case, how XXXXXXX can it be for me to only receive 750mg (I weigh 190) versus receiving 1000mg? The guy that weighs 10 pounds more gets 1000mg. Should I eat more to gain 10 more pounds? Technically because of my weight and the calculations on the Orencia web-site, I should be receiving 860mg, but it only comes in 3 sizes. 500, 750, & 1000mg. Taking into consideration all that information, in your opinion, wouldn't trying 1000mg at least be worth a try? Having had RA for 16 years, I am here to tell you that starting from square one with a new biologic YET AGAIN, isn't as easy as it sounds. (and being on prednisone for over a year!) Thank-you for your time and patience. PS I cannot tolerate Methotrexate or Arava
XXXXXXX,
Your argument seems quite reasonable. Though I would be tempted to use a higher dose of abatacept for you based on your argument, I doubt whether your doctor would do it. Again, this is from fear of legal implications which may ensue on crossing upper prescribed dose (just in case, if any complications).
The company decides the dosages based on extensive research on animals and volunteers. They (dosages) are based on data available from the studies. The FDA does not permit a medication to be used in dosages not yet studied (though logically it could correct). It is possible that the permitted dosages could increase in future after the drugs are studied further. However, in current scenario, it could be difficult.
Lastly, you should not be pessimistic in trying a new drug. It is possible that the newer medication may act faster and could be more effective. For example, infliximab (remicade) can act just in about 2 weeks and is very effective for RA.
Good luck with your health
Dr Jadhav
Your argument seems quite reasonable. Though I would be tempted to use a higher dose of abatacept for you based on your argument, I doubt whether your doctor would do it. Again, this is from fear of legal implications which may ensue on crossing upper prescribed dose (just in case, if any complications).
The company decides the dosages based on extensive research on animals and volunteers. They (dosages) are based on data available from the studies. The FDA does not permit a medication to be used in dosages not yet studied (though logically it could correct). It is possible that the permitted dosages could increase in future after the drugs are studied further. However, in current scenario, it could be difficult.
Lastly, you should not be pessimistic in trying a new drug. It is possible that the newer medication may act faster and could be more effective. For example, infliximab (remicade) can act just in about 2 weeks and is very effective for RA.
Good luck with your health
Dr Jadhav
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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