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Ustekinumab for psoriasis

Author: Anoma Ranaweera B.V. Sc; PhD (Clinical Biochemistry, University of Liverpool, UK), 2011. Reviewed and revised by Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, September 2014.

What is ustekinumab?

Ustekinumab (brand name STELARA™) is a biological treatment used to treat moderate to severe psoriasis. It is a human monoclonal antibody that antagonises interleukin-12 (IL-12) and IL-23. Good to excellent responses are seen in more than two-thirds of patients with chronic plaque psoriasis treated with ustekinumab.

Ustekinumab has been shown in small studies to be useful in other forms of psoriasis, including nail psoriasis, erythrodermic psoriasis, generalised pustular psoriasis and palmoplantar pustulosis and blah. It is under investigation in the treatment of psoriatic arthritis and Crohn disease.

How does ustekinumab work in psoriasis?

Psoriasis is caused by an increase in the production of T-cells and is influenced by cytokines, the chemical messengers produced by cells. Certain cytokines cause skin cells to grow rapidly, producing plaques of psoriasis. Ustekinumab is a monoclonal antibody that targets the p40 subunit of the cytokines IL-12 and IL-23, preventing them from binding and activating T-lymphocytes.

Dosing of ustekinumab

Ustekinumab is given by subcutaneous injection. The second dose is given 4 weeks after the first injection, and further doses are delivered every 12 weeks. It reaches its peak effect at around 28 weeks.

Adverse events due to ustekinumab

To date adverse infections are consistent with that seen with other biologics.

Precautions when considering ustekinumab

Vaccinations and ustekinumab

Immunisation status should be reviewed prior to starting ustekinumab. If necessary, vaccines should be updated prior to treatment with a biologic agent. Annual influenza vaccination is recommended.

As they may induce illness in immunodeficient individuals, live vaccines should not be used during treatment with ustekinumab. Currently available live attenuated viral vaccines include measles, mumps, rubella, varicella, yellow fever, influenza (intranasal vaccine) and oral polio vaccine. Live attenuated bacterial vaccines include BCG and oral typhoid vaccine.

Read more about immunisation in immunosuppressed dermatology patients ...

Drug interactions with ustekinumab

Use of ustekinumab in specific populations

Pregnancy Category B

There are no studies of ustekinumab in pregnant women. Ustekinumab should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nursing mothers

Caution should be exercised when ustekinumab is administered to a nursing woman. The unknown risks to the infant from gastrointestinal or systemic exposure to ustekinumab should be weighed against the known benefits of breast-feeding.

Paediatric use

Safety and effectiveness of ustekinumab in children have not been evaluated.

Hepatic and renal impairment

No pharmacokinetic data are available in patients with liver or kidney disease treated with ustekinumab.

Monitoring while on ustekinumab

It is recommended that patients on biologic medications have routine blood tests every 6 months or so, including full blood count and liver function tests. TB testing should be repeated from time to time.

New Zealand approved datasheets are the official source of information for these prescription medicines, including approved uses and risk information. Check the individual New Zealand datasheet on the Medsafe website.

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