Ustekinumab was recently approved in Canada and the U.S. for the treatment of psoriasis, but is not approved for the treatment of psoriatic arthritis. Several large studies have been conducted and research is ongoing regarding its use in psoriatic arthritis.
Ustekinumab is the first of a new class of medications that targets chemical messengers known as interleukin-12 (IL-12) and interleukin-23 (IL-23). These are naturally occurring proteins that are important in regulating the immune system and believed to be associated with certain immune-related inflammatory diseases, such as psoriasis. This new medication regulates IL-12 and IL-23, reducing the inflammation in the skin cells and helping to control the signs and symptoms of psoriasis. Of interest, it is becoming increasingly clear that IL23 and a new type of recently described T-cell (T-helper 17) are of central importance in the development of psoriasis. Interleukin-23 stimulates the growth and the survival of T-helper 17 cells, which may be of central importance in stimulating the skin cell to proliferate, resulting in the changes of psoriasis.
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| Ustekinumab For Psoriasis |
Research trials that have involved targeting interleukin-12 and interleukin-23 have shown some of the highest response rates in the treatment of psoriasis, supporting the central role of these molecules in the cause of psoriasis.
How Is Ustekinumab Given?
Ustekinumab is given by an injection just under the surface of the skin. It is self-administered as a 45 milligram dose administered at week zero, and then week four. It is then given every twelve weeks thereafter. In patients who have a body weight greater than 220 pounds (100 kilograms), 90 milligrams may be used as an alternate dose. For certain patients not responding to this dose, ustekinumab may be given every eight weeks.
Your doctor or nurse will give you detailed instructions for preparing and giving an injection. There is also an information package provided with your medication that will give you step-by-step instructions. If you have any questions, ask your doctor or nurse.
What Can You Expect from Ustekinumab?
Clinical studies have established that ustekinumab has shown an excellent improvement in psoriasis. Research in the use of ustekinumab in psoriatic arthritis is encouraging, but the medication is not yet approved for the treatment of psoriatic arthritis. Ustekinumab is found to be among the most effective treatments in the management of psoriasis with 67-76 percent of patients who received two doses at 45 or 90 milligrams, respectively, at week zero and week four achieving an excellent improvement (75 percent improvement) compared with approximately 3-4 percent of patients receiving a placebo when assessed at 12 weeks after the first injection. Long-term results from these studies have indicated a sustained benefit in the majority of patients.
An additional study compared ustekinumab with etanercept in approximately 900 patients with psoriasis. Two groups of patients received either the 45 or 90 milligram dose of ustekinumab (at weeks zero and four) or the 50 milligram dose of etanercept (received twice weekly during twelve weeks). Study results showed that 68 percent and 74 percent of patients receiving ustekinumab at 45 or 90 milligrams, respectively, achieved an excellent response (75 percent improvement in the Psoriasis Area Severity Index) compared with 57 percent of those patients receiving 50 milligrams of etanercept. The safety profile was similar between these two drugs when examined in the short term, up to 12 weeks. Long-term safety differences between these two drugs, if any, are not known.
As seen with the other biologic agents, continuing to give additional therapy over time can provide additional benefit.
What Should You Tell Your Doctor before Starting Ustekinumab?
You should tell your doctor if you:
- are pregnant or plan on becoming pregnant
- are breast-feeding
- have problems with your immune system (i.e., HIV/AIDS)
- have a history of cancer
- have tuberculosis, have had it, or have recently been exposed to it; you will need to have a tuberculosis skin test done prior to starting ustekinumab therapy
- have had recent severe infection, or are prone to infections or recurring infections
- are taking any other medications or herbal supplements
- have an allergy to ustekinumab or any of its components
How Do You Store Ustekinumab?
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| Ustekinumab For Psoriasis |
Ustekinumab is provided in a vial that should be stored in the refrigerator at 36°-46°F (2°-8°C). The medication is a colorless to light-yellow fluid that may contain a few white particles. If your dose is 45 milligrams, you will receive one 45 milligram vial. If your dose is 90 milligrams, you will receive two 45 milligram vials and will need to give yourself two injections, one right after the other.
Make sure you check the expiration date stamped on the carton. If it is past the expiration date, you cannot use it. In addition, check the vial to make sure that it is not damaged, and the liquid is not cloudy or frozen. To find out more, you can check out Ustekinumab For Psoriasis.