An interleukin (IL-12/23) inhibitor biologic
Ustekinumab
An injected biologic that blocks the IL-12 and IL-23 immune signals, used for psoriasis, psoriatic arthritis and some bowel conditions.
What is Ustekinumab?
Ustekinumab is a biologic medicine that calms an overactive immune system by blocking two messenger proteins, IL-12 and IL-23, that drive inflammation. It is used for moderate to severe plaque psoriasis, psoriatic arthritis, and the inflammatory bowel conditions Crohn's disease and ulcerative colitis. It is given by injection under the skin, with the first dose for bowel disease sometimes given as a drip into a vein. Because it dampens part of the immune system, infection is the main caution, so you will usually be screened for tuberculosis and hepatitis first and should avoid live vaccines during treatment.
Education and reference only. This is a plain-language guide to Ustekinumab — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Ustekinumab is a biologic medicine, a type of treatment made from living cells that acts on a precise part of the immune system. It targets two related messenger proteins, interleukin-12 and interleukin-23, which help drive the inflammation behind psoriasis and some other long-term conditions. It is used for moderate to severe plaque psoriasis, psoriatic arthritis, and the inflammatory bowel diseases Crohn's disease and ulcerative colitis, usually when other treatments have not worked well enough. It is given by injection under the skin, and for bowel disease the very first dose may be given as a drip into a vein in hospital.
How it works
In conditions such as psoriasis, the immune system becomes overactive and produces too much inflammation. Ustekinumab attaches to interleukin-12 and interleukin-23, two proteins that act as signals telling immune cells to keep the inflammation going. By blocking these signals, it turns down the overactivity that causes thickened, scaly skin, joint swelling or bowel inflammation. Because it targets specific signals rather than the whole immune system, it is more focused than older immunosuppressant medicines, but it still leaves you somewhat more prone to infection.
Company & origin
Originated / developed by: Janssen (originator); biosimilars available.
A biologic medicine developed to treat moderate to severe plaque psoriasis and several immune-driven conditions by targeting specific signals in the immune system.
Practical use
How to take Ustekinumab
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given by injection under the skin; after training, many people give the injections themselves at home, with doses spaced weeks apart.
- For Crohn's disease or ulcerative colitis, the first dose is often given as a drip into a vein in hospital, followed by under-the-skin injections.
- Before starting, expect to be screened for tuberculosis and hepatitis, as the treatment can let a hidden infection flare.
- Avoid live vaccines while you are being treated, and try to be up to date with recommended non-live vaccinations beforehand.
- Tell your team promptly about any fever, persistent cough or infection that will not settle, and keep your regular review appointments.
Weighing it up
Advantages & disadvantages of Ustekinumab
Advantages
- Effective for moderate to severe plaque psoriasis and psoriatic arthritis, often clearing skin and easing joints when other treatments have not worked.
- Targets specific immune signals, so it is more focused than older, broader immunosuppressant medicines.
- Given only every several weeks once established, and can usually be self-injected at home after training.
Disadvantages
- It dampens part of the immune system, so it can make infections more likely and may allow a hidden tuberculosis or hepatitis infection to flare.
- Live vaccines must be avoided during treatment.
- It is a biologic given by injection and needs screening before starting and ongoing monitoring.
Practical use
Good to know
The key thing to understand is that ustekinumab works by quietening part of the immune system, so infection is the main caution: it is less broad than older immunosuppressants but the risk is still real. Before you start, you will usually be screened for tuberculosis and hepatitis, because the treatment can allow a hidden infection to flare. While you are on it you should avoid live vaccines, and it helps to stay up to date with recommended non-live vaccinations beforehand. Tell your team promptly if you develop a fever, a persistent cough, or any infection that will not settle. After training, many people give the injections themselves at home, and the doses are spaced weeks apart. It is generally well tolerated, but it is a long-term treatment that needs ongoing review.
Who should not take it / use with caution
- People with a serious active infection should not start it until the infection is treated.
- It is used with caution, and only after assessment, in those with untreated tuberculosis or active hepatitis.
- Live vaccines should be avoided during treatment, so this needs planning around any travel or immunisations.
Monitoring
- Screening for tuberculosis and hepatitis before starting, and watching for signs of infection throughout treatment.
- Reviewing how well the skin, joints or bowel symptoms are responding so treatment can be adjusted.
- Checking vaccination status and planning any immunisations around the treatment.
Side effects
- More frequent infections, such as colds, chest or sinus infections, are the most important effect to watch for.
- Headache, tiredness, and redness or soreness where the injection is given are common and usually mild.
- Rarely, more serious infections or allergic reactions, which need urgent medical attention.
Key interactions
- Combining it with other medicines that suppress the immune system can add to the infection risk and is done only with specialist advice.
- Live vaccines should not be given during treatment because the immune response to them may be unsafe.
- Tell your team about all your medicines, as some long-term conditions and treatments affect how it is used.
Available as: Injection under the skin (including pre-filled pens for self-injection after training); an initial dose into a vein for bowel disease.
Answers
Ustekinumab: frequently asked questions
How is ustekinumab given?
It is given by injection under the skin, and after training many people inject it themselves at home; for Crohn's disease or ulcerative colitis the first dose is often a drip into a vein in hospital.
Why do I need tests before starting?
Because it calms part of the immune system, you are usually screened for tuberculosis and hepatitis first, as the treatment can let a hidden infection flare.
Can I have my usual vaccinations?
You should avoid live vaccines during treatment; it is best to be up to date with recommended non-live vaccinations before you start, and your team can advise.
Does it make infections more likely?
It can, because it dampens part of the immune system, so tell your team promptly about any fever, persistent cough or infection that will not settle.
How often will I need it?
Once treatment is established, injections are usually spaced several weeks apart, which many people find convenient compared with daily medicines.
The wider class
About Interleukin (IL-12/23) inhibitor biologic
Ustekinumab belongs to the interleukin (il-12/23) inhibitor biologic class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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