Stelara (ustekinumab)

What it is

Stelara (ustekinumab) is a biologic medicine that blocks two proteins, interleukin-12 and interleukin-23 (IL-12 and IL-23), which help drive inflammation in the skin and joints. It treats psoriatic arthritis and plaque psoriasis, helping both the joints and the skin. It has been in use since 2009, so there is a long track record of experience with it. Stelara is a maintenance treatment, given on a regular schedule to keep inflammation controlled.

Before starting

Before starting, we screen for tuberculosis (TB) with a blood test. Immune-calming medicines can let a hidden, inactive TB infection become active, so finding and treating any inactive infection first is a key safety step. We also check that your vaccinations are up to date: live vaccines — including the BCG vaccine — should not be given during treatment, and completing vaccines before the first dose lets your immune system respond to them fully. Treatment is not started during an active infection. Tell us about any history of cancer or frequent infections so we can review them together.

How it’s given

It is an injection under the skin that you can learn to give yourself at home with a pre-filled syringe or pen. After starter doses in the first weeks (weeks 0 and 4), it is taken once every 12 weeks. The dose depends partly on body weight — people over about 220 pounds (100 kg) often receive a higher dose, because larger bodies clear the medicine faster and need more to reach the same level. Store it in the refrigerator, let it warm to room temperature before injecting, and rotate sites between the thigh, belly, and upper arm.

What to expect

Skin and joint improvement builds over the first 2–3 doses, with results usually judged around 3–6 months. The most common side effects are a stuffy nose, sore throat, and other cold symptoms, headache, tiredness, and — in psoriatic arthritis — back pain; injection sites may be sore or red for a day or so. Because immune defence is somewhat lowered, infections can occur — call promptly for fever or an infection that is not improving. Keep taking Stelara on schedule even when you feel completely well: the wide spacing works because each dose lasts, but only if the next dose arrives on time.

Everyday guidance

If a dose is late, take it as soon as you remember and then count 12 weeks from that dose for the next one. Most people on Stelara need no routine lab monitoring. Keep the medicine refrigerated in its carton, never frozen. Tell other clinicians — including your dentist — that you are on an immune-calming biologic, and check with us before vaccines or surgery. If you are planning a pregnancy, discuss timing with your provider. Questions or worries: call the office at (361) 400-7700.