Ustekinumab

How it works

Ustekinumab binds the shared p40 subunit of interleukin-12 and interleukin-23, preventing these cytokines from engaging their receptor and thereby down-regulating the Th1 and Th17 inflammatory pathways central to psoriatic plaque formation.

Prescribing in practice

• As an immunosuppressant it increases infection risk, so active serious infection must be excluded and latent tuberculosis screened for and treated before starting, with patients advised to report signs of infection.
• Live vaccines should be avoided during treatment, and immunisations brought up to date beforehand where possible.
• It is a specialist-initiated biologic prescribed within defined disease-severity criteria, with caution in those with a history of malignancy.

Monitoring

Screen for tuberculosis, hepatitis and other infection before initiation and monitor clinically for infection and treatment response thereafter, in line with biologic protocols.

Counselling the patient

• After loading doses, the injection is given as maintenance every few months; attend planned reviews.
• Report fever, persistent cough or other signs of infection promptly.
• Tell other clinicians you are on a biologic, and avoid live vaccines unless cleared by your specialist.

Evidence & guidelines

Ustekinumab is recommended by NICE for adults with severe plaque psoriasis meeting defined criteria, based on the PHOENIX trials demonstrating significant skin clearance versus placebo.