Stelara (ustekinumab) injections are used to treat types of plaque psoriasis, psoriatic arthritis, Crohn’s disease and ulcerative colitis, which are all autoimmune conditions. Stelara is an immunosuppressant medication that helps reduce inflammation by targeting a specific chemical substance in the body.

Stelara is a monoclonal antibody from a group of medicines called interleukin (IL) inhibitors. People who have autoimmune conditions have higher levels of certain proteins called interleukin-12 (IL-12) and interleukin-23 (IL-23). Stelara works by blocking the activity of these proteins, which reduces inflammation, pain, swelling, and skin symptoms that you may have.

Stelara was first FDA-approved on September 25, 2009 for adults with moderate to severe psoriasis.

What is Stelara used for?

Stelara is FDA-approved to treat:

• Plaque psoriasis (moderate to severe) in patients 6 years and older who are candidates for phototherapy or systemic therapy.
• Psoriatic arthritis (active) in patients 6 years and older.
• Crohn’s disease (moderately to severely active) in adults.
• Ulcerative colitis (moderately to severely active ) in adults.

You should not use Stelara if you have received a BCG (Bacillus Calmette and Guérin) vaccine within 1 year prior to, during, or 1 year following treatment.

Before you start treatment with this injection, your doctor may perform tests to make sure you do not have tuberculosis.

Serious infections may occur during treatment with Stelara. Call your doctor right away if you have signs of infection such as fever, chills, muscle pain, shortness of breath, weight loss, diarrhea or stomach pain, burning when you urinate, feeling very tired, skin warmth or redness, painful skin sores, or coughing up blood.

Ustekinumab may also cause a rare but serious condition affecting the brain called Posterior Reversible Encephalopathy Syndrome (PRES). Tell your doctor right away if you have a headache, confusion, vision problems, or a seizure.

Stelara may decrease the activity of your immune system, and there may be an increase in your risk for certain types of cancers. Tell your doctor if you have ever had any type of cancer. Some people who are receiving this medicine and have risk factors for skin cancer have developed certain types of skin cancers. During your treatment with this medicine, tell your doctor if you develop any new skin growths.

Before you start treatment with this medicine, your doctor may perform tests to make sure you do not have tuberculosis or other infections.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.  Stelara is intended for use under the guidance and supervision of your doctor. Prepare your injection only when you are ready to give it. Do not use if the medicine looks cloudy, has changed colors, or has particles in it. Call your pharmacist for new medicine.

Crohn’s disease and ulcerative colitis the first dose of Stelara is given through a vein in the arm (intravenous infusion) in a healthcare facility by your healthcare provider. It takes at least 1 hour to receive the infusion. Your next doses will be given as an injection under the skin (subcutaneous injection).

Psoriasis or psoriatic arthritis Stelara is given as an injection under the skin (subcutaneous injection) as described below.

Injecting Stelara under your skin

• In children 6 years and older, it is recommended that this medicine be administered by a healthcare provider.
• If your doctor decides that you or a caregiver may give your injections at home, you should receive training on the right way to prepare and inject Stelara. 
• Your doctor will determine the right dose for you, the amount for each injection, and how often you should receive it. Your dose needs may change if you gain or lose weight.
• Do not try to inject yourself unless you or your caregiver have been shown how to use it by your doctor or nurse.
• Inject Stelara under the skin in your upper arms, buttocks, upper legs (thighs) or stomach area (abdomen). 
• Do not give an injection in an area of the skin that is tender, bruised, red or hard. 
• Use a different injection site each time you use this medicine. 
• Use a needle and syringe only once and then place them in a puncture-proof "sharps" container. Follow state or local laws about how to dispose of this container. Keep it out of the reach of children and pets.
• Be sure to keep all of your scheduled follow-up appointments.

Crohn’s disease and ulcerative colitis Stelara is given as an infusion for the first dose then as a subcutaneous injection every 8 weeks thereafter. 

Psoriasis and Psoriatic Arthritis Stelara is given as a subcutaneous injection initially and 4 weeks later, then a dose is given every 12 weeks.

Dose is dependent on the patient's weight.

For more Stelara dosing information, click on the link below.

Stelara is available as:

Subcutaneous Injection

• single-dose prefilled syringe  (45 mg/0.5 mL or 90 mg/mL) 
• single-dose vial (45 mg/0.5 mL)

Intravenous Infusion 

•  single-dose vial 130 mg/26 mL (5 mg/mL)

You should not use Stelara if you:

• are allergic to the active ingredient ustekinumab or any of the inactive ingredients contained in the medicine. Click here for a full list of Stelara ingredients

• have active tuberculosis; or
• have received a BCG (Bacillus Calmette and Guérin) vaccine within the past 12 months.

Tell your doctor if you have ever had tuberculosis, if anyone in your household has tuberculosis, or if you have recently traveled to an area where tuberculosis is common.

To make sure Stelara is safe for you, tell your doctor if you have:

• signs of infection (fever, chills, cough, muscle aches, painful skin sores, diarrhea, pain when you urinate, feeling very tired)
• chronic infections
• new or changing skin lesions
• a latex allergy as the needle cover on the prefilled syringe contains latex
• phototherapy (light therapy)
• allergy shots
• if you recently received or are scheduled to receive any vaccine, people who take this medicine should not receive live vaccines. Tell your doctor if anyone in your house needs a live vaccine. The viruses used in some types of live vaccines can spread to people with a weakened immune system, and can cause serious problems.

Some people using this medicine have developed skin cancer (non-melanoma). However, these people may have had a higher risk of skin cancer. Talk to your doctor about this risk and what skin symptoms to watch for. You may need to have regular skin exams.

Pregnancy

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. If you are pregnant, your name may be listed on a pregnancy registry to track the effects of ustekinumab on the baby.

Breastfeeding

It may not be safe to breast-feed while using this medicine. It is thought that Stelara passes into your breast milk in small amounts. Talk to your doctor about the best way to feed your baby if you receive this medicine.

Call your doctor for instructions if you miss a dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.

Do not receive a "live" vaccine while using this medicine, and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to you. Live vaccines include measles, mumps, rubella (MMR), rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

BCG vaccine should not be given for at least 1 year after you receive your last dose of Stelara.

Non-live vaccines (including flu shots) may not work as well during your treatment, and may not fully protect you from disease. Make sure you are current on all vaccines before you begin treatment with this medicine.

Get emergency medical help if you have signs of an allergic reaction to Stelara: hives; chest pain, difficult breathing; feeling light-headed; swelling of your face, lips, tongue, or throat.

Serious infections may occur during treatment with Stelara. Call your doctor right away if you have signs of infection such as: fever, chills, muscle pain, shortness of breath, weight loss, diarrhea or stomach pain, burning when you urinate, feeling very tired, skin warmth or redness, painful skin sores, or coughing up blood.

Also call your doctor at once if you have:

• a mole that has changed in size or color;
• swelling, pain, warmth, or redness anywhere on your body;
• stomach pain that is sudden and severe or comes on slowly, changes in bowel habits (diarrhea or constipation);
• new or worsening cough, sudden chest pain, feeling short of breath;
• pain or burning when you urinate; or
• severe headache, confusion, change in mental status, vision problems, and/or seizure (convulsions).

Common Stelara side effects may include:

• fever, flu-like symptoms;
• infection;
• itching;
• stomach pain, nausea, vomiting, diarrhea;
• vaginal itching or discharge;
• pain or burning when you urinate;
• cough with mucus, shortness of breath, chest discomfort;
• headache, tiredness; or
• redness at the injection site.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Other drugs may interact with Stelara, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

It is important to tell your doctor if you are taking any of the following: 

• anticoagulants (blood thinners) such as warfarin (Coumadin, Jantoven)
• medications that suppress the immune system such as azathioprine (Azasan, Imuran), cyclosporine (Gengraf, Neoral, Sandimmune), methotrexate (Otrexup, Rasuvo, Trexall, Xatmep), sirolimus (Rapamune), and tacrolimus (Astagraf, Envarsus, Prograf)
• oral steroids such as dexamethasone (Hemady), methylprednisolone (Medrol), and prednisone (Rayos). 

Your doctor may need to change the doses of your medications or monitor you carefully for side effects.