Mirikizumab

How it works

It selectively binds the p19 subunit of interleukin-23, blocking this cytokine and thereby reducing the downstream inflammatory signalling that drives mucosal inflammation in ulcerative colitis.

Prescribing in practice

• Screen for active and latent tuberculosis and other serious infections before starting, and do not initiate during an active clinically important infection.
• Treatment is given as intravenous induction followed by subcutaneous maintenance dosing.
• Avoid live vaccines during treatment and bring immunisations up to date beforehand where possible.

Monitoring

Monitor for signs of infection and clinical response, and assess liver enzymes as advised in the prescribing information.

Counselling the patient

• Advise patients to report symptoms of infection promptly while on treatment.
• Explain that those on maintenance may be trained to self-inject, and to attend for review of disease response.

Evidence & guidelines

Mirikizumab is recommended by NICE as an option for moderately to severely active ulcerative colitis within its licensed use.