STELARA (Ustekinumab)

What is this medication?

Ustekinumab, Stelara
Antipsoriatic Agent; Interleukin-12 Inhibitor; Interleukin-23 Inhibitor; Monoclonal Antibody

Officially indicated for Crohn disease, ulcerative colitis, plaque psoriasis, and psoriatic arthritis.

How does this medication work? 

Stelara/Ustekinumab is a humanized monoclonal antibody that binds to proinflammatory cytokines and mediators such as interleukin-12 and -23.  Stelara/Ustekinumab also interferes with the expression of monocyte chemotactic protein-1 (MCP-1), tumor necrosis factor-alpha (TNF-α), interferon-inducible protein-10 (IP-10), and interleukin-8 (IL-8). Significant clinical improvement in psoriasis and psoriatic arthritis patients is seen in association with reduction of these proinflammatory signalers.

How should I take this medication? 

Crohn Disease
Induction IV: 260mg to 520mg as a single dose; dependant on bodyweight

Maintenance SQ: Inject 90mg every 8 weeks after IV induction dose 

Plaque Psoriasis
SQ: Inject 45mg to 90mg at 0, 4 weeks and then 12 weeks thereafter.

Psoriatic Arthritis
SQ: Inject 45mg at 0, 4 and then 12 weeks thereafter.

Ulcerative Colitis
Induction IV: 260mg to 520mg as a single dose; dependant on bodyweight

Maintenance SQ: Inject 90mg every 8 weeks after IV induction dose 

How to Take Ustekinumab, Stelara: Intravenous administration of Ustekinumab/Stelara should be done under the direct supervision of a medical professional.  Ustekinumab/Stelara is generally administered at an infusion clinic. When administering Ustekinumab/Stelara by subcutaneous injection, inject into the top of the thigh, abdomen, upper arms, or buttocks. Rotate sites. Do not inject into tender, bruised, erythematous, or indurated skin. Avoid areas of skin where psoriasis is present. Discard any unused portion. Intended for use under supervision of physician; self-injection may occur after proper training. 

What should I watch for while using this medication? 

Antibody formation

Hypersensitivity reactions have been reported including anaphylaxis and angioedema

Risk of developing infections, malignancy, neurotoxicity

Do not use in patients with active or latent tuberculosis infection

What if I miss a dose?

If you miss a dose of Stelara, talk with your doctor. They can help set up a new dosing schedule.

How should I store this medication?

Stored in the refrigerator (but NOT in the freezer compartment). Do not be freeze or shake. Keep the product in the original carton to protect it from light until the time of use. Refrigerate it immediately at 36°F to 46°F (2°C to 8°C). Never keep Ustekinumab, Stelara beyond the expiration date printed on the carton and the label.

What are the possible side effects of using this medication?

The most common side effects reported in using Stelara/Ustekinumab include:

>10%:

Immunologic: Antibody development (3% to 12%; associated with reduced efficacy in psoriasis patients)

Infection: Infection (psoriasis: 27% to 72%; infection, severe: ≤3%)

Respiratory: Nasopharyngitis (11% to 24%)