IL-23 Inhibitors

Administration: Subcutaneous injection

Dose:

• The recommended dose of USTEKINUMAB is an initial dose of 45 mg, followed by a dose 4 weeks later and further doses every 12 weeks thereafter.
• A dose of 90 mg may be used in people with a body weight over 100 kg.

Time to response: 2 weeks to 3 months

Indication: Psoriatic Arthritis.

Contraindications:

• Pregnancy & breast feeding.
• Active infection including TB.
• Latex allergy.

Cautions:

• History of malignancy.
• Predisposition to infection.
• Active tuberculosis should be treated with standard treatment for at least 2 months before starting USTEKINUMAB.

Monitoring:

• Monitor for non-melanoma skin cancer, especially in patients with a history of PUVA treatment or prolonged immunosuppressant therapy, or those over 60 years of age.
• Monitor for signs and symptoms of exfoliative dermatitis or erythrodermic psoriasis.

Vaccinations:

• Avoid live attenuated vaccines.
• Offer annual influenza vaccination.
• In those who are biologic naïve pneumococcal vaccination and Sars-Cov-2 vaccination should ideally be performed at least 2 weeks before commencing biologic treatment.
• Assuming no contraindications before starting treatment:
  • Patients >50 should undergo vaccination against HZV.
  • Those who are varicella zoster negative should be offered varicella vaccination.

In the event of:

• Injection site reaction – usually settles without further intervention.
• Sore throat/fever/bruising/pallor – stop USTEKINUMAB and check FBC.
• Serious infection – stop USTEKINUMAB and restart once infection resolved.
• Surgery – stop 1 week prior to surgery and resume after wound healingz.
• Increasing dyspnoea – stop USTEKINUMAB and arrange CXR.
• Start appropriate treatment if widespread erythema and skin exfoliation develop, and stop USTEKINUMAB treatment if exfoliative dermatitis suspected.

Administration: Sub-cutaneous injection

Dose: GUSELKUMAB 100mg 8 weekly, occasionally 4 weekly in severe disease.

Prescribing: Prescriptions will be issued by the Rheumatology Department and delivered to the patient via Homecare Services.

Time to response: Up to 24 weeks

Indication: Psoriatic Arthritis.

Contraindications:

• Pregnancy.
• Active infection including HBV, HCV & HIV or active/latent TB.

Monitoring:

• Blood monitoring will be the responsibility of the prescribing department.
• Liver function tests every 6 months.

Vaccinations:

• Avoid live attenuated vaccines.
• Offer annual influenza vaccination
• In those who are biologic naïve pneumococcal vaccination and Sars-Cov-2 vaccination should ideally be performed at least 2 weeks before commencing biologic treatment.
• Assuming no contraindications before starting treatment:
  • Patients >50 should undergo vaccination against HZV.
  • Those who are varicella zoster negative should be offered varicella vaccination.

Contraception: Is advised whilst on treatment and for 12 weeks after receiving GUSELKUMAB.

In the event of:

• Infection - withhold GUSELKUMAB until infection treated.
• If you have any concerns regarding a patient who has recently received GUSELKUMAB please contact the rheumatology department.