Psoriasis: Ustekinumab

  • Indications: moderate-severe psoriasis 
  • Dosing: 45 mg of ustekinumab at baseline, 4 wk, and every 12 wk in those < 100 kg, and 90 mg of ustekinumab at same intervals for those > 100 kg
  • Short-term efficacy: PASI-75 in 67% at 12 wk
  • Long-term efficacy: PASI-75 maintained in 87% of patients at 52 wk who attained PASI-75 at wk 12
  • Toxicities:
    • Occasional injection-site reactions
    • Rare reports of serious infections and malignancies including skin cancers
    • Rare reports of major adverse cardiovascular events
    • Single report of reversible posterior leukoencephalopathy
  • Baseline monitoring: (similar to other biologic agents)
    • PPD is required
    • LFT, CBC, and hepatitis profile
  • Ongoing monitoring:
    • Periodic history and physical examination recommended while on treatment
    • Yearly PPD, and consider periodic CBC and LFT
  • Pregnancy category B
Strength of Recommendation: A   Level of Evidence: I

Navigate section 6 of the psoriasis guideline: Case-based review

Citation note

Menter A, Korman NJ, Elmets CA,Feldman SR, Gelfand JM, Gordon KB, Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011 Jul;65(1):137-74. 

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