Stelara is an effective addition to the medication options for patients with autoimmune disease, but the sheer number of medication options out there can be overwhelming. Perhaps your health care provider has suggested Stelara as a potential treatment option for you, or maybe you’re investigating your options and want to know more about it. In this article, we’ll explain what Stelara is, what it is used for, how to use it, and its side effects. We’ll also go over some potential alternative or complementary approaches to Stelara, so you can be well informed about all your options.

What Is Stelara?

Stelara, the brand name for the generic ustekinumab, is a prescription medication that helps control inflammation in your body. Stelara, or Ustekinumab,  does this by blocking the action of two pro-inflammatory proteins, interleukin-12 and interleukin-23, which are thought to play an important role in the increased inflammation seen in some autoimmune conditions. Ustekinumab is currently the only medication approved by the U.S. Food and Drug Administration (FDA) that targets interleukin-12 and interleukin-23. (Source, Source, Source)

Importantly, while ustekinumab helps improve symptoms, it doesn’t cure autoimmune diseases. This isn’t a limitation specific to ustekinumab — all autoimmune medications work to reduce symptoms, as autoimmune diseases cannot currently be cured.

Stelara is likely not the first medication you will try for your autoimmune condition, but it may be your first biologic medication. A biologic medication is a drug that is derived from biological sources, such as living cells or tissues, in a complex combination. This is different from a conventional medicine, such ibuprofen, which is synthesized from non-biological chemicals. This difference in source does not affect the safety or effectiveness of the drug — in fact, biologics are often the cutting-edge of medicine. (Source)

What Is Stelara Used For?

Ustekinumab can be used to manage symptoms in a number of different medical conditions, all of which are autoimmune related. We don’t know the exact cause of these autoimmune conditions, but studies suggest that an overactive immune response is a big contributor. By decreasing inflammation, ustekinumab can provide temporary relief. (Source)

Plaque Psoriasis

Plaque psoriasis is the most common type of psoriasis, and is characterized by scaly, itchy, raised patches on your skin. These plaques often appear on the knees, scalp, lower back, and elbows, but can really show up anywhere on the body. As plaque psoriasis progresses, patients may also develop swelling in the joints. (Source, Source)

Psoriatic Arthritis

Psoriatic arthritis is a form of arthritis that is associated with psoriasis. It generally develops after the red, scaly patches typical to psoriasis, but the skin lesions don’t always show up first. Symptoms of psoriatic arthritis can include:

• swollen joints
• stiffness in joints
• joint pain
• swollen fingers or toes
• stiffness and pain in the lower back

(Source)

Use of Stelara to help with psoriatic arthritis is somewhat recent, having been approved by the FDA for this use in 2022. (Source)

Crohn’s Disease

Crohn’s disease is a type of inflammatory bowel disease that can affect any part of the digestive tract. Symptoms of Crohn’s disease can vary from person to person, but common symptoms include:

• constipation
• cramping
• diarrhea
• abdominal pain
• weight loss
• fatigue

(Source)  

Ulcerative Colitis

Ulcerative colitis is another type of inflammatory bowel disease that affects the large intestine and rectum. Symptoms of ulcerative colitis can be similar to Crohn’s disease, such as:

• diarrhea
• abdominal pain
• weight loss
• fatigue
• rectal pain/bleeding

(Source)

How Long Will Stelara Take To Work?

Everyone’s experience will be different, but we can look at the results of clinical studies to get an idea of what you might experience.

In clinical studies of ustekinumab in patients with plaque psoriasis, participants saw a noticeable improvement in their skin after 12 weeks. In studies of patients with psoriatic arthritis, many patients had an improvement in their joint and skin symptoms after 24 weeks. (Source)

In clinical studies of ustekinumab in patients with Crohn’s disease, over half of the patients studied reported improvement in their symptoms after 6 weeks. Some patients even experienced remission (meaning having very few or no symptoms) within 3 weeks. However, the official guidelines for ustekinumab say to expect symptom improvement after around 8 weeks of treatment. (Source, Source)

How Long Do I Need to Take Stelara?

As ustekinumab does not cure your autoimmune condition, you will need to continue taking it to have continued improvement in your symptoms. However, clinical studies of ustekinumab do suggest that if the medication is helping you feel better, you are likely to continue feeling better. In the study of patients with Crohn’s disease, about half of the patients were in remission after 44 weeks of taking ustekinumab. A similar scenario was seen in the study of patients with plaque psoriasis: In a review of patients taking ustekinumab, more than 80% of patients had minimal symptoms of plaque psoriasis after 8 years. (Source, Source)

How Do I Use Stelara?

Ustekinumab will be provided to you in a syringe that is already filled with the drug solution. Your health care provider should teach you (or your caregiver/partner/friend/etc.) how to properly and safely inject ustekinumab just underneath your skin, known as a subcutaneous injection.

If you are taking ustekinumab to help with your plaque psoriasis and psoriatic arthritis, it will be injected once, then once again 4 weeks later, and then every 12 weeks after that.

If you are taking ustekinumab to help with your Crohn’s disease or ulcerative colitis, you will receive the drug through an intravenous injection at your health care professional’s office. Afterwards, you can self-inject subcutaneously at home every 8 weeks. (Source)

What Are The Common Side Effects?

Like any medication, ustekinumab may cause side effects. Overall, these side effects happened very rarely in clinical studies, but they are important for you to know about. Talk to your health care professional to make sure you understand these risks and how to recognize the symptoms of these serious side effects.

The most common side effects vary depending on your condition.

Plaque Psoriasis

• headache
• fatigue
• upper respiratory tract infection
• bronchitis
• sinusitis

(Source, Source)

Crohn’s Disease

• redness at the injection site
• itchy skin
• upper respiratory tract infection
• urinary tract infection
• vaginal yeast infection
• vomiting

(Source, Source)

Ulcerative Colitis

• headache
• abdominal pain
• influenza
• fever
• diarrhea
• fatigue
• upper respiratory tract infection
• nausea

(Source, Source)

These side effects may happen just after you inject ustekinumab and then go away on their own, or they may last a few days. If you experience any of these symptoms and they’re causing you concern, be sure to talk to your health care provider.

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Less Common (But More Serious) Side Effects

Additionally, ustekinumab comes with a potential for some rare, but more serious, adverse effects.

Infection

Because ustekinumab reduces inflammation by decreasing the activity of your immune system, you may be at an increased risk of infection. Your health care provider will check you for specific risks of infections, such as tuberculosis (TB) before starting treatment. You may receive treatment for TB if your health care provider feels it is necessary, and you will be monitored for TB or signs of infection while you are taking ustekinumab. You shouldn’t start using ustekinumab if you have an active infection. (Source, Source)  

Cancer

Because ustekinumab affects immune response, there may be an increased risk of some types of cancer. However, this increased risk has not been seen in every study. (Source, Source, Source)

Allergic Reactions

If you’re allergic to or have had a previous reaction to any ingredient in ustekinumab and its medical equipment, you should not take it. Your health care provider can offer you other medication options to try instead. Let your provider know if you’re allergic to latex, as the needle cap contains latex. (Source)

Posterior Reversible Encephalopathy Syndrome (PRES)

The cause of this potentially life-threatening condition that affects the brain is unknown, but has been associated with immune suppressing medications. There are a few case reports of patients experiencing PRES after starting treatment with ustekinumab. (Source, Source, Source)

Lung Inflammation

There is a minor risk of lung inflammation, if you notice a cough that doesn’t go away or unusual shortness of breath, be sure to contact your health care provider as soon as possible. (Source, Source)

What Else Do I Need to Know About Stelara?

There’s more to consider before starting treatment with Stelara.

Use with Other Drugs

Let your health care provider know if you are taking warfarin or cyclosporine, as ustekinumab may affect how they work. Because ustekinumab dampens immune response, you should not get live vaccines while on it. You can get non-live vaccines, but you might not have a strong enough immune response to make them effective. Clinical studies suggest that you’re okay to take methotrexate with ustekinumab if you have psoriasis or psoriatic arthritis, and to take immunomodulators or corticosteroids if you have Crohn’s disease or ulcerative colitis. (Source, Source, Source)

Pregnancy

Clinical studies of ustekinumab did not include patients who were pregnant, so we don’t have enough information to know if it’s safe to use during pregnancy or breastfeeding. Make sure to tell your health care provider if you are pregnant, thinking about becoming pregnant, or breastfeeding. (Source)

Alternatives to Stelara

Stelara can be a life-changing medication for some, but every person is unique and it may not work for you. Keep in mind there are other ways to manage your autoimmune condition beyond Stelara, and even if the medication is improving your symptoms, incorporating these methods could help you feel even better.

For many people with autoimmune conditions, nutrition and lifestyle changes can greatly improve their day to day life. A dedicated nutritional therapist can help guide you through all the alternative or complementary options available. If you’re curious to learn how comprehensive lifestyle management may help you, WellTheory’s approach may be a good place to start. Here are some suggestions for additional lifestyle changes  you can consider.

Food Choices

Paying close attention to your diet can greatly improve your symptoms, as certain foods may trigger or worsen your symptoms. Keeping a food diary can help keep track of how you feel after eating specific foods. Food choices are particularly relevant for patients with Crohn’s or ulcerative colitis as the diseases specifically affects the gastrointestinal tract, but dietary modifications have also been shown to help with psoriasis symptoms. (Source, Source)

Incorporating more anti-inflammatory foods into your diet could also be an easy way to help with your symptoms. Some foods that are also known to be anti-inflammatory include leafy greens, honey, berries, fatty fish, and turmeric. If you’re interested in diving further into using your diet to manage your symptoms, the autoimmune protocol (AIP) diet is a detailed way to discover which foods can trigger your symptoms and which foods work better for your body.

Stress

When your body is stressed, a hormone called cortisol is released. Initially, this response is healthy and acts to decrease inflammation in your body, but excessive release of cortisol can trigger an overactive immune response and contribute to your autoimmune symptoms. Thus, decreasing stress can help. Stress management techniques such as meditation have been shown to decrease symptoms of psoriasis, as well as help with Crohn’s disease. (Source, Source)

Sunlight

For patients with psoriasis, UV light has been shown to help improve or even resolve the psoriasis rash. Phototherapy is the medically approved treatment that uses various UV lights and lasers to reduce the psoriasis. However, patients with psoriasis will often notice that sitting for a day on the beach can help their symptoms, and the research supports that observation. (Source, Source)

Herbal Options

Many herbal remedies are mentioned in autoimmune discussion, though few have been comprehensively tested in the conditions we’ve been discussing. However, in clinical studies, topical indigo naturalis has been shown to help relieve psoriasis rash, as has curcumin (which is the main anti-inflammatory factor in turmeric). Curcumin may also help with the gastrointestinal inflammation in Crohn’s disease and ulcerative colitis. (Source, Source)

The Bottom Line on Stelara

If you have plaque psoriasis, psoriatic arthritis, Crohn’s disease, or ulcerative colitis, you may be considering Stelara to help reduce your symptoms. By decreasing the high level of inflammation present in autoimmune conditions, Stelara can reduce joint swelling, improve rash, and help with digestive and gastrointestinal issues. However, as with any new medication, make sure you fully understand the potential side effects and drug interactions, and discuss any concerns with your provider.

And if you’re interested in natural options to manage your autoimmune symptoms, or complementary methods to try while also taking Stelara, WellTheory’s Care Team is here to help.