NICE guidance - Ustekinumab for the treatment of adults with moderate to severe psoriasis (psoriatic) arthritis

• ustekinumab is recommended as an option in the management of active psoriatric arthritis, alone or in combination with methotrexate (1) only when
  • treatment with tumour necrosis factor (TNF) alpha inhibitors is contraindicated but would otherwise be considered (as described in NICE technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis and golimumab for the treatment of psoriatic arthritis ) or
  • the person has had treatment with 1 or more TNF-alpha inhibitors
    
    
• manufacturer provides the 90 mg dose (two 45 mg vials) for people who weigh more than 100 kg at the same total cost as for a single 45 mg vial
• ustekinumab treatment should be stopped if the person's psoriatic arthritis has not shown an adequate response using the Psoriatic Arthritis Response Criteria (PsARC) at 24 weeks. An adequate response is defined as an improvement in at least 2 of the 4 criteria (1 of which must be joint tenderness or swelling score), with no worsening in any of the 4 criteria.
• when using the PsARC, healthcare professionals should take into account any physical, sensory or learning disabilities, or communication difficulties that could affect the responses to the PsARC and make any adjustments they consider appropriate

Notes:

• ustekinumab is a fully human monoclonal antibody that targets interleukin-12 (IL-12) and IL-23
  • binds to the p40 subunit, common to both IL-12 and IL-23, which prevents these cytokines from binding to the cell surface of T cells, thereby disrupting the inflammatory cascade implicated in psoriasis
  • ustekinumab has a UK marketing authorisation for 'the treatment of moderate to severe plaque psoriasis in adults who have failed to respond to, or who have a contraindication to, or are intolerant to other systemic therapies including ciclosporin, methotrexate and PUVA' (1)
  • summary of product characteristics (SPC) states that ustekinumab is intended for use under the guidance and supervision of a physician experienced in the diagnosis and treatment of psoriasis
  • common adverse events associated with ustekinumab, as reported in the SPC, include upper respiratory tract infection, nasopharyngitis, depression, headache, dizziness, diarrhoea, pruritus, back pain, fatigue and injection site erythema
  • contraindications listed in the SPC include clinically important active infection and hypersensitivity to the active substance or to any of the excipients. For full details of side effects and contraindications, see the SPC

Reference:

• 1. NICE (June 2015).Ustekinumab for the treatment of adults with moderate to severe psoriasis