Prescribing information For Healthcare Professionals Only

ACTIVE INGREDIENT(S):

Ustekinumab

Please refer to Summary of Product Characteristics (SmPC) before prescribing.

INDICATION(S): 

Plaque psoriasis adults: Treatment of moderate to severe plaque psoriasis in adults who failed to respond to, or who have a contraindication to, or are intolerant to other systemic therapies including ciclosporin, methotrexate or PUVA.
Plaque psoriasis paediatrics: Moderate to severe plaque psoriasis in children and adolescent patients from 6 years of age, who are inadequately controlled by, or are intolerant to, other systemic therapies or phototherapies.
Psoriatic arthritis: Alone or in combination with methotrexate for treatment of active psoriatic arthritis in adult patients when response to previous non-biological disease-modifying anti-rheumatic drug (DMARD) therapy has been inadequate.
Crohn's disease: Treatment of adult patients with moderately to severely active Crohn’s disease who had inadequate response with/lost response to/were intolerant to either conventional therapy or TNFα antagonist or have contraindications to such therapies.
Ulcerative colitis: Treatment of adult patients with moderately to severely active ulcerative colitis who had an inadequate response with/lost response to/were intolerant to either conventional therapy or a biologic or have contraindications to such therapies.

DOSAGE & ADMINISTRATION:

Adults: Under guidance and supervision of a physician experienced in diagnosis and treatment of psoriasis/psoriatic arthritis/Crohn’s disease/ulcerative colitis. 
Psoriasis or psoriatic arthritis: Subcutaneous (s.c.) injection. Avoid areas with psoriasis. Self-injecting patients or caregivers ensure appropriate training. Physicians are required to follow-up and monitor patients.
Plaque psoriasis, adults & elderly: Patients up to and including 100kg, 45 mg at week 0 followed by a 45 mg dose at week 4, then every 12 weeks. Patients greater than 100 kg, 90 mg at week 0 followed by a 90 mg dose at week 4, then every 12 weeks (45 mg was less effective in these patients).
Plaque psoriasis paediatrics (6 years and older): Patients under 60 kg, 0.75 mg/kg at week 0, followed by 0.75 mg/kg at week 4 then every 12 weeks thereafter. Patients 60 - 100kg, 45 mg at week 0 followed by 45 mg at week 4, then every 12 weeks. Patients greater than 100 kg, 90mg at week 0, followed by 90mg at week 4, then every 12 weeks. The pre-filled pen has not been studied in the paediatric population and is not recommended for use in paediatric patients across all the indications.  
Psoriatic arthritis, adults & elderly: 45 mg at week 0 followed by a 45 mg dose at week 4, then every 12 weeks. Alternatively, 90 mg may be used in patients with a body weight greater than 100 kg.
Consider discontinuation if no response after 28 weeks.
Crohn's disease and ulcerative colitis: Initial single intravenous infusion dose based on body weight (260 mg or 390 mg or 520 mg) diluted in sodium chloride solution and given over at least one hour. At week 8 after intravenous dose, 90 mg s.c. dose is given; followed by every 12 weeks (or 8 weeks based on clinical judgement). Consider discontinuation if no response 16 weeks after the IV induction dose or 16 weeks after switching to the 8-weekly maintenance dose. Immunomodulators and/or corticosteroids may be continued but consider reducing/discontinuing corticosteroids if responding to STELARA®. If therapy interrupted, resumption s.c. every 8 weeks is safe/effective.

Children:
Under 6 years: Not recommended for psoriasis. 
Under 18 years: Not recommended for psoriatic arthritis, Crohn's disease and ulcerative colitis.
Renal & Hepatic impairment: Not studied.

CONTRAINDICATIONS:

Hypersensitivity to product; clinically important, active infection.

SPECIAL WARNINGS & PRECAUTIONS:

Infections: Potential to increase risk of infections and reactivate latent infections. Opportunistic infections have been reported in patients treated with ustekinumab. Caution in patients with a chronic infection or history of recurrent infection, particularly TB. Patients should be evaluated for tuberculosis prior to initiation of STELARA®. Consider anti-tuberculosis therapy prior to initiation of STELARA® in patients with history of latent or active tuberculosis. Patients should seek medical advice if signs or symptoms suggestive of an infection occur. If a serious infection develops, closely monitor and STELARA® should not be administered until infection resolves.

Malignancies: Potential to increase risk of malignancy. Risk of malignancy may be higher in psoriasis patients treated with other biologics. No studies in patients with history of malignancy or in patients who develop malignancy while receiving STELARA®. Monitor all patients, in particular those older than 60, patients with a medical history of prolonged immunosuppressant therapy or those with a history of PUVA treatment for non-melanoma skin cancer.
Cardiovascular events: Cardiovascular events have been observed in patients with psoriasis in a post-marketing observational study; cardiovascular risk factors should be regularly assessed during treatment.
Concomitant immunosuppressive therapy: Caution, including when changing immunosuppressive biologic agents.
Hypersensitivity reactions: Serious hypersensitivity reactions (anaphylaxis and angioedema) reported, in some cases several days after treatment. If these occur appropriate therapy should be instituted and STELARA® discontinued.
Latex sensitivity: Needle cover contains natural rubber (latex), may cause allergic reactions.
Immunotherapy: Not known whether STELARA® affects allergy immunotherapy.
Serious skin conditions: Exfoliative dermatitis reported following treatment. Discontinue STELARA® if drug reaction is suspected. Infusion-related anaphylactic reactions to the infusion have been reported. If a serious or life-threatening reaction is observed, appropriate therapy should be instituted and ustekinumab should be discontinued.
Lupus-related conditions: Cases of lupus-related conditions have been reported in patients treated with ustekinumab. If lesions occur, especially in sun exposed areas of the skin or if accompanied by arthralgia, the patient should seek medical attention promptly.

SIDE EFFECTS:

Common: upper respiratory tract infection, nasopharyngitis, sinusitis, dizziness, headache, oropharyngeal pain, diarrhoea, nausea, vomiting, pruritus, back pain, myalgia, arthralgia, fatigue, injection site erythema, injection site pain.
Other side effects: Uncommon: cellulitis, skin exfoliation, lower respiratory tract infection Rare: serious hypersensitivity reactions (including anaphylaxis, angioedema), hypersensitivity vasculitis, exfoliative dermatitis Very rare: bullous pemphigoid, cutaneous lupus erythematosus, lupus-like syndrome.
Studies show adverse events reported in children 12 years and over with plaque psoriasis were similar to those seen in previous studies in adults with plaque psoriasis.
Refer to SmPC for other side effects.

FERTILITY:

The effect of ustekinumab has not been evaluated.

PREGNANCY:

Should be avoided. Women of childbearing potential: Use effective contraception during treatment and for at least 15 weeks post-treatment.

LACTATION:

Limited data from published literature suggests that ustekinumab is excreted in human breast milk in very small amounts.

INTERACTIONS:

In vitro, STELARA® had no effect on CYP450 activities.
Vaccinations: Live vaccines should not be given concurrently with STELARA®, and should be withheld for at least 15 weeks after last dose of STELARA®. STELARA® can resume at least 2 weeks after such vaccinations. No data on secondary transmission of infection by live vaccines in patients receiving STELARA®.
Concomitant immunosuppressive therapy: Psoriasis: Safety and efficacy of STELARA in combination with other immunosuppressants, including biologics, or phototherapy have not been evaluated. Psoriatic arthritis: concomitant MTX did not appear to affect STELARA®. Crohn’s disease and ulcerative colitis: concomitant immunosuppressive or corticosteroid therapy did not appear to affect STELARA®.

Refer to SmPC for full details of interactions. 

LEGAL CATEGORY: Prescription Only Medicine (POM)

MARKETING AUTHORISATION HOLDER: 

Northern Ireland: Janssen-Cilag International NV, Turnhoutseweg 30, B-2340 Beerse, Belgium.

Great Britain: Janssen-Cilag Limited, 50-100 Holmers Farm Way, High Wycombe,  Buckinghamshire HP12 4EG UK.

FURTHER INFORMATION IS AVAILABLE FROM: Janssen-Cilag Limited, 50-100 Holmers Farm Way, High Wycombe, Buckinghamshire, HP12 4EG, UK.

Prescribing information last revised: October 2023