The drug Stelara is a FDA monoclonal antibody that is used to primarily treat Crohn’s disease, ulcerative colitis, psoriasis, and psoriatic arthritis (1). Monoclonal antibodies are made by identical immune calls that are all clones of a unique parent cell (3). These will bind to the same part of an antigen as its parent cell to elicit inhibitory actions against the infectious organism.
Stelara works via injections that suppresses the immune response chemicals (IL-12 & IL-23) that cause damaging inflammation. Stelara will not cure the disease it is used to treat, but only produce less symptoms in affected individuals (the reduced inflammation). Stelara effects the innate and acquired immune system by inhibiting IL-23 and IL-12. IL-23 and IL-12 are produced by some antigen presenting cells. IL-23 facilitates the transition of naive T helper cells into Th17 which will secrete several inflammatory cytokines such as IL-17 and IL-22 (4). IL-12 promotes the differentiation of Th1, this will secrete interferon gamma and TNF (tumor necrosis factor)(4). These responses are essential to the inflammatory response, during these chronic diseases inflammation becomes a problem because the immune system goes into over drive and the system doesn’t shut off.
Overall Side effects of Stelara
- malignancy
- Reversible posterior leukoencephalopathy syndrome (one case reported)
- Infections from the following vaccines
- mycobacterium
- salmonella
- bacillus calmette-guerin
Patients with psoriasis:
- Nasopharyngitis
- Upper respiratory tract infection
- Headache
- fatigue
- diarrhea
- back pain
- dizziness
- pharyngolaryngeal pain
- pruritus
- injection site erythema
- myalgia
- depression
Patients with psoriatic arthritis:
- Arthralgia,
- nausea
- dental infections
Patients with Crohn’s disease
- nasopharyngitis
- injection site erythema
- vulvovaginal candidiasis/mycotic infection
- bronchitis
- pruritus
- urinary tract infection
- sinusitis
- vomiting
Due to the increased risk of developing a serious infection from many kinds of bacterium, patients considering Stelara should be screened for a latent TB infection if TB status is unknown. Patients with TB are not recommended to take Stelara as their immune system is already too compromised to out weigh the risks.
References
- https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/761044lbl.pdf
- https://www.stelarainfo.com/
- https://en.wikipedia.org/wiki/Monoclonal_antibody
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6158482/
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