The ARA has released usage recommendations to optimise available supplies.
Abatacept shortages are anticipated from June 2024 onwards, the manufacturer BMS has announced today, mirroring similar difficulties related to supply chains during the covid pandemic in 2022.
While the TGA, PBAC and Services Australia are yet to announce their responses, the Australian Rheumatology Association has advised in a letter to members today that usage recommendations are in line with the response to the previous shortage in 2022, which in turn were similar to recommendations applied following the shortage of tocilizumab starting in 2021.
These include recommendations that:
- no new patients be started on abatacept SC or IV
- patients be moved off abatacept where possible
- stock be conserved for patients who have prior use of two other b/tsDMARDs and/or relative or absolute contraindications to other b/tsDMARDs
- for people who meet the above criteria and need to stay on abatacept consider increasing the dosing interval if clinically appropriate
- patients are not to be moved from single dose syringe or ClickJect prefilled autoinjector to the IV presentation except in exceptional circumstances.
The ARA has indicated that more information will be communicated to members as it becomes available.
The 2021 tocilizumab shortage was thought to be related to utilisation of tocilizumab for hyperinflammatory states related to covid, at a time when many affected people had not been vaccinated, and the 2022 abatacept shortage was thought to be a consequence of increased use of abatacept as a substitute for tocilizumab. It is not yet clear if any such issue has precipitated this shortage.
During the 2022 shortage, a prolonged absence of abatacept supply led to difficulties for many patients.
BMS has indicated that other countries have been affected by this shortage, although it is currently unclear whether patients and clinicians in the US are similarly affected.
Abatacept continues to be investigated within disease states related to rheumatoid arthritis. This includes in early rheumatoid arthritis with high ACPA titres, where a head-to-head double-blind randomised controlled trial of abatacept versus adalimumab is expected to report shortly.
Additionally, in patients with the pre-rheumatoid arthritis state of high-risk clinically suspect arthralgias, the APIPPRA and ARIAA studies published in The Lancet in February demonstrated some capacity to prevent progression to rheumatoid arthritis.
