This clinical review outlines a practical approach for the use of ustekinumab in psoriasis treatment. Ustekinumab is a human immunoglobulin G (IgG)1-kappa monoclonal antibody antagonist of the p40 subunit of interleukin (IL)-12 and IL-23. Ustekinumab was approved by the Food and Drug Administration in September 2009 for treatment of patients aged 18 years and older with moderate to severe plaque psoriasis who are eligible for phototherapy or other systemic therapy. Its efficacy and safety have been evaluated in two large phase III clinical trials: PHOENIX 1 and PHOENIX 2. Proper dosing is based on a fixed dose determined by patient body weight and administered by a health care provider with two starter doses 4 weeks apart, followed by maintenance dosing every 12 weeks. Adverse events—including serious infections, malignancy, reversible posterior leukoencephalopathy syndrome, and cardiovascular events (e.g., sudden cardiac death, myocardial infarction, or stroke)—have been reported. Attention to warnings, precautions, and appropriate patient selection regarding ustekinumab can assist dermatologists in safely prescribing this new biologic agent for psoriasis patients.
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