Medical Necessity of Orencia (Abatacept) for Psoriatic Arthritis

Patient Clinical Profile and Treatment

A 66-year-old female patient with polyarticular psoriatic arthritis who has failed multiple previous biologic therapies, including Enbrel, Cosentyx, Humira, and Simponi Aria, is considered for Orencia (abatacept) IV therapy 1, 2
The patient has moderate joint pain and stiffness affecting multiple joints, and the current treatment with Enbrel and mycophenolate has shown no significant difference 1
The patient's provider assessment indicates that the current illness treatment goals are not met and are considered unstable 1

The patient has previously received biologics indicated for active psoriatic arthritis with inadequate response, meeting the criteria for Orencia therapy 3, 1
Appropriate screening, including negative tuberculosis, Hepatitis B, and Hepatitis C screenings, has been completed 1
The recommended dosing regimen for the patient's weight is 750mg IV at weeks 0, 2, 4, and then every 4 weeks 1
The patient will discontinue the current biologic (Enbrel) before starting Orencia 1

Abatacept is FDA-approved and medically necessary for psoriatic arthritis in patients who have failed previous biologic therapies, according to the Journal of the American Academy of Dermatology 3
Guidelines support switching to a different mechanism of action, such as abatacept, after failure of TNF inhibitors in psoriatic arthritis, as recommended by the American College of Rheumatology 1, 2
Patients with psoriatic arthritis who fail multiple TNF inhibitors often benefit from switching to a different class of medication, such as abatacept 2, 4

Periodic clinical assessment of joint symptoms and function is recommended for patients on Orencia therapy 7, 8
Assessment of response using validated measures, such as ACR response criteria or DAS28, is recommended 7, 8
Annual tuberculosis screening is recommended for patients on Orencia therapy 3, 1
Periodic complete blood count (CBC) and liver function tests (LFT) are recommended to monitor for potential adverse events 3, 6