Ustekinumab

INTRODUCTION

Indications

Treatment of adults with moderate-to-severe plaque psoriasis who are candidates for phototherapy or systemic therapy.

Action

Binds to the p40 protein subunit used by both the interleukin-12 (IL-12) and IL-23 cytokines. These cytokines that are involved in inflammatory and immune responses, including natural killer cell activation and CD4+ T-cell differentiation and activation. Binding to interleukins antagonizes their effects, disrupting IL-12– and IL-23–mediated signaling and cytokine cascades. Therapeutic Effects: ↓ in area and severity of psoriatic lesions.

Adverse Reactions/Side Effects

CNS: fatigue, headache. Local: erythema. Misc: INFECTION, REVERSIBLE POSTERIOR LEUKOENCEPHALOPATHY SYNDROME.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of reversible posterior leukoencephalopathy. Signs include headache, confusion, memory lapses, decreased cognition, vision loss, and seizures. Report these signs to the physician immediately.

• Watch for signs of infection, including fever, sore throat, chills, nausea, vomiting, diarrhea, and localized inflammation. Notify physician immediately.

• Periodically assess skin condition to document whether drug therapy is successful in decreasing the size and severity of psoriatic lesions.

• Monitor injection site for redness and warmth. Report prolonged or excessive injection-site reactions to the physician.

Interventions

• Implement ultraviolet light therapy when indicated to help treat psoriasis and augment the effects of drug therapy.

Patient/Client-Related Instruction

• Instruct patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

• Instruct patient to report other troublesome side effects, including severe or prolonged headache or fatigue.

Pharmacokinetics

Absorption: Well absorbed following SC administration.

Distribution: Unknown.

Metabolism and Excretion: Broken down by catabolic processes into peptides and amino acids.

Half-life: 15–46 days.

Contraindications/Precautions

Contraindicated in: Active untreated infection.

Use Cautiously in: History of known malignancy or tuberculosis (possibility of reactivation); OB: Use during pregnancy only if potential benefit justifies potential risk to the fetus. Lactation: Use cautiously in nursing women; unknown risks to infant from gastrointestinal/systemic exposure should be weighed against known benefits of breast-feeding. Pedi: Safe and effective use in patients <18 yr not established.

Exercise Extreme Caution in: Chronic infection or history of recurrent infection.

Interactions

Drug-Drug: May ↓ antibody response to and ↑ risk ...