Stelara, generic ustekinumab, is a new biologic treatment for psoriasis. It has shown excellent ability in studies to reduce the area and severity of psoriasis plaques and needs to be given only 5 times per year. Additionally, Stelara seems to have low incidence of side effects.
In contrast, the current biologic treatment for psoriasis need to be given much more often, may have more significant side effects, and many are not as effective.
Chemically, Stelara is a fully human monoclonal antibody to interleukin-12 and 23. This means that it acts much like a heat-seeking missile that knocks out your body’s natural level of interleukin (IL)-12 and 23.
This is important as those are two messengers which seem to be heavily involved in generating the abnormal immune response which characterizes psoriasis.
Stelara may somehow disrupt the natural balance of the body’s immune system. This arises from the fact that interleukins are used by the body to control its immune response. By targeting IL12 and 23, Stelara could weaken the body’s immune system and increase susceptibility to infection or cancer.
Other concerns include the possibility of an immune response against Stelara or the potential for cardiac issue.
Studies to date, however, have supported Stelara as a safe and effective treatment.
Studies have shown that Stelara is a very effective treatment for psoriasis.
Using the Psoriasis Area and Severity Index (PASI) to measure response, roughly 90% of those treated with Stelara have at least a 50% decrease in their PASI score. And about 70% of those taking Stelara will have a 75% PASI score decrease.
In one study, about 71% of those on Stelera had a 75% decrease in PASI compared to only 57% of those on Enbrel, a popular treatment.
Other scales of psoriasis severity also show significant improvements.
Can Stelara Cause Cancer?
One analysis, which we could not obtain a full copy of, argues that IL12 & 23 inhibitors have in fact been shown to cause cancer in certain animal models. The piece does not mention at what doses or animal the cancer was shown to occur in.
Even if this is true, however, it is very important to note that there are significant differences between humans and animals. Some substances do cause cancer in animals but are harmless in humans. Additionally, almost anything at a high enough dose will cause toxicity to the body, including potentially cancer.
The studies to date have not supported a significant risk of cancer from Stelara, with the ones we looked at showing similar rates of cancer in those treated with it and those given placebo.
In studies, Stelara had similar rates of side effects as placebo, albeit slightly higher.
In one study, a few patients on Sterala had heart related incidents that required hospitalization, and two had some sort of serious infection. Other, larger studies have not shown similar issues, however.
If you have signs of an allergic reaction like difficulty breathing or facial swelling, make sure to get emergency help.
Because it is theoretically possible for Stelara to compromise your immune system, any abnormal infection or reaction should be reported to your doctor.
Most common side effects include headaches, arthralgia, or join pain, and local reactions near the injection site.
Sterala is a biologic, which means it is significantly more complicated than traditional medications. Roughly 30% of new biologics have some serious adverse event that only is noticed after they are on the market for some time.