Ustekinumab

• While taking ustekinumab you must see your rheumatologist regularly to make sure the treatment is working and check for possible side effects.
• Remember to change the injection site each time ustekinumab is injected.
• If you are worried about any side effects, you should contact your rheumatologist as soon as possible.
• It is important to tell your rheumatologist if you have had cancer or if you develop cancer.
• If you stop ustekinumab for any reason you must contact your doctor. Failure to do so may mean that your continued treatment will no longer be subsidised.
• If you plan to become pregnant you must discuss the timing with your rheumatologist.
• You should continue to take it even if you do not have symptoms.

Ustekinumab is a medicine used for patients who have severe active psoriatic arthritis. It does not work straight away. It may take a number of weeks for you to notice some relief of joint swelling, pain and stiffness.

Stopping ustekinumab

If you stop or delay your ustekinumab treatment, your condition may get worse. Continue with your treatment, unless told by your rheumatologist to stop or unless side effects occur (see Side effects). If you stop ustekinumab for any reason, you must contact your rheumatologist. Failure to do so may mean that your treatment may no longer be subsidised.

Ustekinumab is injected just under the skin (subcutaneously) of the abdomen or thigh. Try to avoid (if possible) any areas of skin involved with psoriasis.

It can be injected by your doctor, nurse, carer or by you. If injecting yourself, be sure to follow the detailed instructions carefully to ensure the best response. You shouldd also change the injection site each time.

Do not shake the vials of ustekinumab at any time. Vigorous shaking may damage the medicine.

Vials that have been shaken vigorously should not be used.

If you forget to use it

If you forget an injection, have the next injection as soon as you remember and continue to use it as you normally would. Do not inject a double dose to make up for the one you missed.

If you have missed more than one dose or are not sure what to do, check with your doctor or pharmacist.

If you have used too much (overdose) 

Contact your doctor straight away or go to your nearest hospital, even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

What is the dosage?

Ustekinumab is a solution for injection that comes in a glass vial. Each vial contains 45mg of ustekinumab. The usual dose of ustekinumab is 45mg (the contents of one vial) injected when you start treatment, then again 4 weeks later, and every 12 weeks after that.

Can other arthritis medicines be taken with ustekinumab?

Ustekinumab may be taken in combination with other arthritis medicines, including:

• steroid medicines such as prednisolone or cortisone injections into the joint
• anti-inflammatory medicines (NSAIDs) such as naproxen (Naprosyn) or ibuprofen (Brufen/Nurofen)
• pain relieving medicines such as paracetamol.

There are separate information sheets for the medicines mentioned above.

How long is the treatment continued?

Treatment can continue with ustekinumab as long as it is effective and you are not experiencing any side effects. Your doctor will tell you how long to continue treatment with ustekinumab. If you see no improvement in your symptoms after 28 weeks of ustekinumab treatment, the treatment will be stopped.

As with most medicines, ustekinumab may cause side effects in some people. You may need medical treatment if you get some side effects.

Tell your doctor if you are concerned about any possible side effects.

Most common possible side effects

The most common side effects with ustekinumab are upper respiratory infections such as sinus infection, sore throat or headache. These are usually mild. Tell your doctor if you are concerned, or if the side effects persist for a long time.

Less common or rare possible side effects

Other less common side effects include dental infections, injection site pain or redness, skin rash or itchiness, diarrhoea or nausea, tiredness or depression.

There are some rare but potentially serious side effects with ustekinumab.

• Serious allergic reaction: Signs of a serious allergic reaction may include a skin rash, a swollen face, lips, mouth or throat, or wheezing, dizziness, trouble swallowing or breathing.
• Tell your doctor or go to the hospital immediately if you have an allergic reaction as you need urgent medical attention.
• Serious infections: ustekinumab may lower your ability to fight infections. Some infections could become serious and you may need to be admitted to hospital. If you have an infection before you start treatment with ustekinumab, you must tell your doctor. If you get an infection while on ustekinumab, tell your doctor straight away.

Other side effects not listed here may also occur. Tell your doctor if you notice any other side effects that you think might be caused by ustekinumab.

Infections

If you have an active infection, treatment with ustekinumab will not be started until the infection is gone. Serious infections such as tuberculosis (TB) are rare, and screening for TB may be needed before treatment begins.

Use with other medicines

• Ustekinumab can interact with some other medicines. You should tell your doctor (including your GP, rheumatologist and others) about all medicines you are taking or plan to take. This includes over-the-counter or herbal/naturopathic medicines. You should also mention your treatment when you see other health professionals.
• Some medicines that ustekinumab may interfere with, include warfarin, and cyclosporin. Make sure your doctor is aware if you are taking these medicines.

Vaccines

• While being treated with ustekinumab you should not be immunised with ‘live’ vaccines such as: MMR (measles, mumps and rubella), Varicella vaccines (Chicken pox/Shingles), OPV (oral polio virus), BCG (Bacillus Calmette Guerin), Japanese Encephalitis or Yellow Fever. Talk with your rheumatologist before receiving any vaccines.
• Tell your doctor if anyone in your house needs a vaccine. THe viruses in some vaccines can spread to people with a weakened immune system and can cause serious problems.
• Pneumococcal, COVID and the yearly seasonal flu vaccinations are encouraged.
• For more information on vaccination including the COVID-19 vaccination, see here.

Surgery

If you require surgery for any reason, you should discuss this with your rheumatologist as some people need to stop taking ustekinumab before surgery.

Pregnancy, breastfeeding and fertility

• The effects of ustekinumab during pregnancy have not been well studied, so it is not clear if it causes birth defects.Small studies suggest that taking ustekinumab during pregnancy is unlikely to be harmful. 
• If you are pregnant or are considering having a child, you should discuss this with your doctor before starting ustekinumab.
• Ustekinumab is likely to pass into the breastmilk of breastfeeding women. If you are breastfeeding, talk to your doctor too decide whether or not to use ustekinumab.

• Store ustekinumab in the fridge, between 2-8ºC. Do not freeze. Keep the vials in the original carton to protect them from light until the time of use. Do not shake the vials.
• Keep all medicines out of reach of children.
• Do not leave ustekinumab in the car, on windowsills or in the bathroom. Heat and dampness can destroy some medicines.

• After injecting ustekinumab, the used syringes should be placed in a puncture-resistant container, like a sharps container. Dispose of your sharps container according to your state or local regulations. If unsure how to dispose of your sharps container, ask your pharmacist.
• Empty vials, antiseptic wipes, and other supplies can be placed in the regular rubbish bin.
• If your doctor tells you to stop using ustekinumab, or the expiry date has passed, ask your pharmacist what to do with the leftover medicine.