Stelara (ustekinumab)Company: Janssen Biotech
Approval Status: Approved September 2009
Treatment for: plaque psoriasis, psoriatic arthritis and Crohn's disease
Areas: Dermatology / Plastic Surgery; Gastrointestinal; Rheumatology
Stelara (ustekinumab) is a human IgG1k monoclonal antibody that binds with high affinity and specificity to the p40 protein subunit used by both the interleukin (IL)-12 and IL-23 cytokines. IL-12 and IL-23 are naturally occurring cytokines that are involved in inflammatory and immune responses, such as natural killer cell activation and CD4+ T-cell differentiation and activation.
Stelara is specifically indicated for:
- Adult patients (18 years or older) with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy.
- Active psoriatic arthritis (PsA), alone or in combination with methotrexate.
- Moderately to severely active Crohn’s disease in patients who have failed or were intolerant to treatment with immunomodulators or corticosteroids, but never failed a tumor necrosis factor (TNF) blocker or failed or were intolerant to treatment with one or more TNF blockers.
Stelara is supplied as a solution for subcutaneous injection. The recommended initial dose of the drug is as follows:
For patients weighing ≤100 kg (220 lbs): 45 mg initially and 4 weeks later, followed by 45 mg every 12 weeks.
For patients weighing >100 kg (220 lbs): 90 mg initially and 4 weeks later, followed by 90 mg every 12 weeks. The 45 mg dose was also shown to be efficacious in this population. However, 90 mg resulted in greater efficacy in these subjects.
Psoriatic Arthritis Recommended Adult Subcutaneous Dosage:
The recommended dosage is 45 mg administered subcutaneously initially and 4 weeks later, followed by 45 mg administered subcutaneously every 12 weeks. For patients with co-existent moderate-to-severe plaque psoriasis weighing greater than 100 kg, the recommended dosage is 90 mg administered subcutaneously initially and 4 weeks later, followed by 90 mg administered subcutaneously every 12 weeks.
Crohn’s Disease Recommended Initial Adult Intravenous Dosage:
A single intravenous infusion using weight-based dosing:
Weight Range (kilogram) and Recommended Dosage:
- Up to 55 kg -260 mg (2 vials)
- Greater than 55 kg to 85 kg - 390 mg (3 vials)
- Greater than 85 kg - 520 mg (4 vials)
The FDA approval of Stelara was based on two multicenter, randomized, double-blind, placebo-controlled studies: STUDY 1 (n=766) and STUDY 2 (n=1,230). All subjects were 18 years of age and older with plaque psoriasis over a minimum body surface area of 10%, and Psoriasis Area and Severity Index (PASI) score >12, and who were candidates for phototherapy or systemic therapy. In both studies, subjects were randomized to the following groups: placebo at Weeks 0 and 4 followed by crossover to Stelara (either 45 mg or 90 mg) at Weeks 12 and 16; or Stelara 45 mg or 90 mg doses, regardless of weight, at Weeks 0, 4, and 16. In both studies, the endpoints were the proportion of subjects who achieved at least a 75% reduction in PASI score (PASI 75) from baseline to Week 12 and treatment success (cleared or minimal) on the Physician’s Global Assessment (PGA). In STUDY 1, the PASI75 response was reached by 3%, 67% and 66% of the placebo and Stelara 45 mg and 90 mg doses, respectively. The PGA of Cleared or Minimal was reached by 4%, 59% and 61% of the placebo, Stelara 45 mg and 90 mg doses, respectively. Subjects in STUDY 1 were evaluated through Week 52. At Week 40, those who were PASI 75 responders at both Weeks 28 and 40 were re-randomized to either continued dosing of Stelara at Week 40 or to withdrawal of therapy (placebo at Week 40). At Week 52, 89% of subjects re-randomized to Stelara treatment were PASI 75 responders compared with 63% of subjects re-randomized to placebo (treatment withdrawal after Week 28 dose). In STUDY 2, the PASI75 response was reached by 4%, 67% and 76% of the placebo and Stelara 45 mg and 90 mg doses, respectively. The PGA of Cleared or Minimal was reached by 4%, 68% and 73% of the placebo, Stelara 45 mg and 90 mg doses, respectively. In subjects who weighed <100 kg, response rates were similar with both the 45 mg and 90 mg doses; however, in subjects who weighed >100 kg, higher response rates were seen with 90 mg dosing compared with 45 mg dosing.
Two randomized, double-blind, placebo-controlled studies, PsA STUDY 1 (n=615) and PsA STUDY 2 (n=312), enrolled adult patients 18 years of age and older with active PsA (>5 swollen joints and ≥5 tender joints) despite non-steroidal anti-inflammatory (NSAID) or disease modifying antirheumatic (DMARD) therapy. Patients were randomized to receive treatment with Stelara 45 mg, 90 mg, or placebo subcutaneously at Weeks 0 and 4 followed by every 12 weeks (q12w) dosing. Approximately 50% of patients continued on stable doses of MTX . The primary endpoint was the percentage of patients achieving ACR 20 response at Week 24. In both studies, a greater proportion of patients achieved ACR 20, ACR 50 and PASI 75 response in the Stelara 45 mg and 90 mg groups compared to placebo at Week 24.
Three randomized, double-blind, placebo-controlled clinical studies were cnducted in adult patients with moderately to severely active Crohn’s disease (Crohn’s Disease Activity Index [CDAI] score of 220 to 450). There were two 8-week intravenous induction studies (UNITI-1 (n=741) and UNITI-2 (n=627)) followed by a 44-week subcutaneous randomized withdrawal maintenance study, representing 52 weeks of therapy. In clinical studies of patients who were either new to, experienced with, or failed biologic therapy (TNF blockers), between 34% (UNITI-1 study) and 56% (UNITI-2 study) of patients experienced relief from their Crohn's disease symptoms in six weeks after receiving the one-time intravenous (IV) infusion of Stelara. Noticeable improvement was observed as early as three weeks. Additionally, the majority of those who responded to induction dosing and continued treatment with Stelara subcutaneous maintenance doses every 8 weeks were in remission at the end of 44 weeks (52 weeks from initiation of the induction dose).
Adverse events associated with the use of Stelara for psoriasis and psoriatic arthritis may include, but are not limited to, the following:
- Upper respiratory tract infection
Adverse events associated with the use of Stelara for Crohn's disease may include, but are not limited to, the following:
Crohn’s Disease, induction
Crohn’s Disease, maintenance
- injection site erythema
- vulvovaginal candidiasis/mycotic infection
- urinary tract infection
Mechanism of Action
Stelara (ustekinumab) is a human IgG1k monoclonal antibody that binds with high affinity and specificity to the p40 protein subunit used by both the interleukin (IL)-12 and IL-23 cytokines. IL-12 and IL-23 are naturally occurring cytokines that are involved in inflammatory and immune responses, such as natural killer cell activation and CD4+ T-cell differentiation and activation. In in vitro models, ustekinumab was shown to disrupt IL-12 and IL-23 mediated signaling and cytokine cascades by disrupting the interaction of these cytokines with a shared cell-surface receptor chain, IL-12 ß1.
For additional information regarding Stelara or plaque psoriasis, psoriatic arthritis and Crohn's disease, please visit https://www.stelarainfo.com/
Stelara Drug Information
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