Stelara (Ustekinumab)

How does Stelara work?

Stelara can be injected into the body to suppress the immune system with an antibody that binds to interleukin (IL)-12 and IL-23. These are chemicals that the body’s cells produce to bring about immune reactions. Scientists believe that when a stimulant, like interleukin, becomes attached to the lymphocyte, the increased production of T-lymphocytes is what causes psoriasis. Skin plaques of psoriasis are caused by skin cells that grow swiftly due to the stimulated T-lymphocytes.

Stelara works by decreasing inflammation and excessive skin cell production which reduces psoriasis symptoms. It attaches to IL-12 and IL-23 to stop them from stimulating T-lymphocytes. In studies, after being treated with Stelara for 12 weeks, between 59% and 73% of patients had cleared or minimal psoriasis.

Dosage

Plaque psoriasis or psoriatic arthritis

Adults with plaque psoriasis or psoriatic arthritis are normally injected with 45 mg which is repeated 4 weeks later. After that, the dose is repeated every 12 weeks. A dose of 90 mg can be prescribed for adults weighing over 100 kg. Also, some people may need to receive their injection at 8-week intervals instead of intervals of 12 weeks.

The injection may be given at the top of the thigh or in the abdomen, roughly a couple of inches away from the belly button.

The dosage for children and adolescents aged between 6 and 17 with plaque psoriasis is based on their weight.

Crohn’s disease and ulcerative colitis

For Crohn’s disease and ulcerative colitis, the first dose is given intravenously and is based on the patient’s body weight. Subsequent 90 mg doses are given at 8-week intervals as injections under the skin. The doctor may increase the interval and injections may be given every 12 weeks instead.

Most people using Stelara can be taught by a medical professional to administer the injection themselves. For the first dose, or the first few doses, patients should be assisted by their doctor, or a nurse, to prepare their Stelara injection and take it. It is important that patients do not attempt to administer the injection themselves until they have been trained and know the process.

When taking Stelara, patients should always follow the instructions given by the doctor or pharmacist. Patients should remove the medication from the refrigerator, ready the syringe, and prepare their chosen spot for the injection before giving themselves the injection, as their medical professional has taught them.

The medication might contain small clear or white protein particles. The solution should be slightly yellow or colorless. If you see other particles floating in the solution, or if the solution looks cloudy or discolored, it should not be used.

Side Effects

Not everyone who uses Stelara will experience the side effects listed below. If you are concerned about the possible side effects, you should discuss them, along with the benefits of Stelara with your doctor before you take it.

At least 1% of the patients taking Stelara have reported the following side effects. In many cases, these can be managed, or may naturally dissipate over time. Your pharmacist may be able to provide guidance for managing the side effects of Stelara, but you should speak with your doctor if they are severe or become a nuisance.

• back pain
• diarrhea
• dizziness
• headache
• pain, redness, or swelling at the injection site
• itchiness
• nausea
• muscle or joint pain
• upper respiratory tract infection symptoms
• tiredness
• toothache or infection
• vaginal yeast infection
• vomiting

While the following side effects don’t often occur, they can cause significant issues if you do not follow up with your doctor or medical professional.

• red skin and increased shedding
• itchy and painful rash
• signs of infection
  • fever
  • chills
  • severe diarrhea
  • shortness of breath
  • prolonged dizziness
  • headache
  • stiff neck
  • weight loss
  • listlessness
• signs of skin cancer, such as unusual moles with:
  • irregular borders
  • multicolored moles
  • large or asymmetrical moles
  • small, sensitive bumps on the skin
  • red, raised, scaly patches of skin
• skin infection signs, such as redness, swelling, sensitiveness, and warmth

If any of the following appear, immediately stop using Stelara and find medical help.

• allergic reaction signs, such as:
  • difficulty breathing
  • hives
  • swelling of the face, lips, tongue, or throat

Other side effects may occur, you should see your doctor if you develop any symptoms that worry you whilst on Stelara.

Warnings & Precautions

Before starting treatment with Stelara, let your doctor know of any allergies or medical issues you have. Make sure they are aware of all the other medication you are taking. Let them know if you are pregnant, or breastfeeding, or if there are any other health-related issues your doctor needs to know about, as these may have an impact on how you should take Stelara.

Allergies

Seek immediate medical attention if you have any allergic reactions. These include:

• severe rash
• hives
• swollen face or throat
• difficulty breathing

Let your doctor know if you are taking any allergy shots, especially if you are taking them for severe allergic reactions. They may impact your dose of Stelara and its effectiveness. Special monitoring may be required.

Immune system

Your immune system’s ability to fight infections may be compromised by using Stelara. That means you’ll risk of picking up infections or inactive infections becoming activated. Before you begin taking Stelara, your doctor might test you for tuberculosis and may continue carrying out regular immune system tests whilst you are on Stelara. You should get in touch with your doctor as soon as possible if you pick up a significant infection.

Cancer

Stelara can increase your risk of cancer, so if you have cancer, or have had it previously, it is advisable that you talk with your doctor about how Stelara might affect your health.

Reversible posterior leukoencephalopathy syndrome (RPLS)

This brain disease is rare but can develop when taking Stelara and might be inadvisable if you have had RPLS before. So make sure your doctor is aware of your previous episode of RPLS. Also, see your doctor if you experience any RPLS symptoms, such as:

• headache
• seizures
• change in awareness, consciousness or vision

Infections

Stelara can have an impact on the way your body uses its natural defenses to fight infections. This means your body can be more vulnerable to infections caused by bacteria, viruses, and fungi.

Pregnancy and breastfeeding

You should not use Stelara during pregnancy unless you and your doctor have considered the benefits and risks. You should seek your doctor’s guidance as soon as you become aware that you are pregnant if you become pregnant while using Stelara. It is not known whether Stelara can be passed from mother to baby through breast milk. However, there is a chance that it can affect your baby if you breastfeed while using Stelara. You should consult your doctor about whether you should carry on breastfeeding if you are using Stelara.

Drug Interactions

Stelara may interact with any of the following drugs, so if you are taking any of them you should let your doctor know or seek guidance from your pharmacist.

• BCG
• baricitinib
• belimumab
• cladribine
• denosumab
• echinacea
• fingolimod
• infliximab
• leflunomide
• natalizumab
• nivolumab
• ocrelizumab
• pimecrolimus
• roflumilast
• siponimod
• tacrolimus
• tofacitinib
• trastuzumab
• upadacitinib
• vaccines

Frequently Asked Questions