Ustekinumab

 

What is Ustekinumab?

Ustekinumab is a targeted disease modifying anti-rheumatic drug (DMARD) that is used to reduce inflammation produced by the body. In certain diseases the immune system is over active, this can target healthy tissues such as joints and the skin. Ustekinumab works on the inflammatory pathway to block inflammation, thereby reducing the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints.

 

What is Ustekinumab used for?

Ustekinumab is used for the treatments of psoriasis and psoriatic arthritis.

 

How is it taken?

Ustekinumab is given as an injection into the layer of fat between the skin and muscle. This is called a subcutaneous injection and is usually given into the thigh or abdomen. It can be given alone or in combination with other DMARDs such as methotrexate.

The injection device is available as a prefilled syringe. It should be stored in the fridge at home.

 

The injections are given initially as loading doses of 45mg or 90mg (depending on your weight) at weeks 0 and 4. You will then take the injection every 12 weeks thereafter.

 

It can take up to 24 weeks (6 months) to have a full effect. You will be seen in clinic at around 3-4 months to see how you are getting along.

 

Whilst you are taking ustekinumab you will need your bloods monitored. This is done every 3 months. If you are taking other DMARDs that require blood monitoring then you should continue these.

 

Side effects

There are a few possible side effects that can occur in a small number of people that take ustekinumab, these include:

 

• Sore throat, headaches and feeling sick
  • These usually settle after taking the medication for a few weeks.
• Increased risk of infections
  • As ustekinumab dampens the immune system, you can be more prone to infection. You should be seen by your GP if you feel unwell in case you need antibiotics. You must temporarily stop your injections whilst you are unwell and receiving treatment, they can be started up again when you feel well.
  • You should try to avoid contact with others that have chicken pox or shingles.
• Subcutaneous injection site reactions
  • Irritation, rashes and blistering can occur
  • Mild steroid creams and antihistamines can be used to settle things down. If these don’t work, then you should see your GP.
• There may be a slight increased risk that your psoriasis may become worse. If this happens you should speak to your doctor, as ustekinumab may need to be stopped.
• There is currently no evidence that ustekinumab increases the risk of developing cancer, however studies are still on going.

 

Cautions of use

Interactions with other medications

• Your doctor will check if there are any medications that could interact.
• You can carry on taking your usual painkillers including NSAIDs.

Contraindications of other conditions

• Before starting any biological therapy, your bloods will be checked for infections that can become active again when the immune system is suppressed, this includes hepatitis B, C and HIV. A blood and chest X-ray is taken to exclude previous TB exposure. If you are found to have had previous TB exposure you may need to start preventative antibiotics for a short period before the ustekinumab is commenced.

Operations

• Ustekinumab should be withheld for 1 week after the last dose would have been due. Therefore surgery can be scheduled for week 13.

During pregnancy and breastfeeding

• There is currently no data on ustekinumab in pregnancy or breastfeeding. Therefore it should not be used.
• If you are considering starting a family, ustekinumab should be stopped at least 15 weeks before trying to conceive.
• There is no data on the use in males who are trying to conceive.

Alcohol

• Alcohol and ustekinumab do not interact, however it is recommended to take alcohol within moderation, following the guidelines of less than 14 units weekly.

Vaccinations

• Flu and the pneumonia vaccine are safe and recommended whilst taking ustekinumab.
• Live vaccines including the shingles vaccine should not be given due to the dampening down of the immune system.

 

Useful Links

Versus Arthritis: http://www.versusarthritis.org