Ustekinumab : a review of the effectiveness of targeting interleukin-12/23P40 in psoriasis and other immune-mediated diseases

Interleukin-12 (IL-12) and interleukin-23(IL-23) are cytokines that have been shown to have a role in the development of several autoimmune diseases including psoriasis, multiple sclerosis, Crohn's disease, and sarcoidosis. IL-12 and IL-23 are heterodimers composed of a p40 subunit and a p35 (IL-12) or p19 (IL-23) subunit. These cytokines activate the T-helper-1 and T-helper-17 pathways. Ustekinumab is a fully human monoclonal antibody that was designed to bind to the p40 subunit found on both IL-12 and IL-23, blocking their effects. Ustekinumab received FDA approval for psoriasis on September 25, 2008 and is being studied as a possible therapy for multiple sclerosis and Crohn's disease. This review examine the safety and efficacy of ustekinumab for psoriasis, multiple sclerosis, and Crohn's disease, compare the efficacy and cost of ustekinumab and etanercept as top line psoriasis treatments, and provide future perspectives for its continued study in these and other immune mediated disorders, such as sarcoidosis and psoriatic arthritis