Ustekinumab

Ustekinumab is used to treat inflammatory types of arthritis, such as psoriatic arthritis.

Ustekinumab is used when there has been an inadequate response to DMARD therapy.  For psoriatic arthritis ustekinumab may be used alone or in combination with methotrexate (MTX).  

Ustekinumab is given by subcutaneous (s.c.) injection (meaning in the fatty layer of tissue just under the skin).  You, a family member or a friend can be taught how to give the injection.

The recommended dose is 45 mg by s.c. injection at week 0 and at week 4, then every 12 weeks thereafter.  For people with a body weight greater than 100 kg a dose of 90 mg may be used

Ustekinumab comes in a single prefilled syringes for the 45 mg dose and 90 mg doses.Single-use vials are not available in Canada.

In some people with arthritis, signalling proteins called interleukin 12 (IL-12) and Interleukin-23 (IL-23) are involved in the body’s inflammatory response where it attacks the body’s own tissues. Ustekinumab works by suppressing the body’s immune system, specifically it blocks IL-12 and IL-23 and prevents them from causing inflammation. By doing this, ustekinumab can help to reduce pain and swelling in the joints, improve day-to-day function, and prevent long term damage to the joints.

Like all of the biologics, you will not feel the effects of ustekinumab right away. Some people begin to feel the effects of ustekinumab within a few weeks; however, it may take three to six months to feel the full effect. It is important to be patient and keep taking your medication.

To provide symptom relief while you are waiting for ustekinumab to take effect, your health-care provider may recommend taking a steroid, such as prednisone or a non-steroidal anti-inflammatory drug (NSAID).

Ustekinumab can make it more difficult for your body to fight infections. People with active infections should not take ustekinumab. If you have a fever, think you have an infection or have been prescribed an antibiotic, contact your health-care provider. People who have had frequent infections in the past or a history of tuberculosis should discuss the use of ustekinumab with their prescriber.   

Also contact your health-care provider if you are having surgery as you may need to stop ustekinumab until you are healed and there is no sign of infection.

Ustekinumab has not been studied in pregnant women or nursing mothers so its effect(s) on pregnant women or nursing babies are unknown. You should tell your doctor if you are pregnant or are planning to become pregnant. Because of the potential for adverse reactions in nursing infants, a decision should be made on whether or not to discontinue nursing or the medication, taking into account the importance of the drug to the mother.

Anyone who has had a previous allergic reaction to ustekinumab should avoid the medication.  

Anyone with a history of cancer or active cancer should discuss this with your health-care provider prior to taking ustekinumab.  Tell your health-care provider if you notice any unusual changes to your skin or health status while taking ustekinumab.

Ideally, your vaccinations should be up to date prior to starting ustekinumab. If you have already started therapy with ustekinumab, your health-care provider will likely recommend most inactive vaccines (e.g., influenza, pneumococcal). Live vaccines are not recommended due to risk of causing infection. Before receiving any vaccinations while taking ustekinumab, you should speak with your health-care provider

Like all medications, taking ustekinumab carries some risk of side effects, which must be balanced with the potential benefits. In general, the risk of joint damage and permanent disability (resulting from arthritis) is much greater than the risks of side effects from ustekinumab. When monitored properly the vast majority of side effects are rare, most improve over time and are reversible.

Firstly, ustekinumab can increase your risk of infections.   The most commonly reported side effect with ustekinumab is symptoms of a cold (sore throat, stuffy nose).

People have also commonly reported experiencing headaches.  Talk to your health-care provider if any of these symptoms affect you severely.

Ustekinumab can rarely cause a reaction (redness, pain, and itching) at the injection site. Talk to your health-care provider if these symptoms become severe.

Rarely people have noticed changes to their skin and increased redness and shedding of the skin.  Contact your health-care provider right away if you notice these symptoms.

Take your ustekinumab as prescribed and contact your health-care provider if you have any concerns while taking the medication.

To avoid injection reactions, injection sites should be rotated and avoid areas where the skin is tender, bruised, red and/or hard.

Blood tests are not routinely required while you are taking ustekinumab. Your health-care provider may order periodic blood tests to check your blood count and follow the activity of your arthritis.

Ustekinumab must be refrigerated at 2 to 8 degrees Celsius and protected from light. Keep the product in the original package and out of the light. 

Ustekinumab must be kept cool while travelling. Ask your pharmacist for a cool carrier if you are not able to put the drug in your refrigerator right away. 

The patient support program for Stelara is called the Janssen CarePath. Their phone number is 1-877-227-3728.