The pathogenesis of
psoriasis is unknown, although it is generally accepted that this chronic inflammatory skin disorder is a complex autoimmune condition similar to other T-cell mediated disorders.
Psoriasis imposes a heavy burden on the lifestyle of those affected due to the psychological, arthritic, and cutaneous morbidities; thus significant research has focused on the genetic and immunologic features of
psoriasis in anticipation of more targeted, efficacious, and safe
therapies. Recently, CD4(+) T helper (Th) 17 cells and
interleukins (IL)-12 and -23 have been important in the pathogenesis of T-cell mediated disorders such as
psoriasis and has influenced the development of medications that specifically target these key immunological players.
Ustekinumab is a
monoclonal antibody belonging to a newly developed class of
biological, anti-
cytokine medications that notably targets the p40 subunit of both
IL-12 and -23, both naturally occurring
proteins that are important in regulating the immune system and are understood to play a role in immune-mediated inflammatory disorders.
Ustekinumab's safety and efficacy has been evaluated for the treatment of moderate-to-severe plaque
psoriasis in 3 phase III clinical trials, 2 placebo-controlled (PHOENIX 1 and 2), and 1 comparator-controlled (ACCEPT) study which proved advantageous in patients who were treatment-naive, previously failed other immunosuppressive medications including
cyclosporine or
methotrexate, were unresponsive to
phototherapy, or were unable to use or tolerate other
therapies.
Ustekinumab has also been investigated for other indications such as
psoriatic arthritis,
Crohn's disease, and
relapsing/remitting multiple sclerosis. We present a concise review evaluating the evidence that supports the use of
ustekinumab in the treatment of plaque
psoriasis and other conditions.