Ustekinumab

How it works

It binds the shared p40 subunit of interleukin-12 and interleukin-23, blocking their interaction with cell-surface receptors and thereby dampening downstream inflammatory pathways.

Prescribing in practice

• Screen for and treat latent tuberculosis and other serious infections before starting, as the drug increases susceptibility to infection.
• An initial intravenous induction dose is typically followed by subcutaneous maintenance therapy at regular intervals.
• Live vaccines should be avoided during treatment, and immunisation status should be reviewed beforehand.

Monitoring

Monitor for signs of infection throughout treatment and reassess the clinical response to decide on continuation.

Counselling the patient

• Report any signs of infection such as fever, persistent cough or feeling generally unwell.
• Tell your clinician you are on this medicine before having any vaccinations.
• Maintenance doses can be given as a subcutaneous injection at home after training.

Evidence & guidelines

NICE recommends ustekinumab as an option for moderately-to-severely active Crohn's disease and ulcerative colitis where conventional or other biological therapy is inadequate.