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Clinical Summary

Psoriasis: ustekinumab blood level at 4 weeks predicts clinical response

Takeaway

  • Higher serum concentrations of ustekinumab (Stelara) at 4 weeks are correlated with clinical response in patients with moderate to severe psoriasis.

Why this matters

  • Serum drug concentration may help identify underexposed patients, but prior results were contradictory for ustekinumab.

Key results

  • At 4 weeks, ustekinumab concentration was negatively correlated with absolute Psoriasis Area and Severity Index (PASI) score (P=.032) and positively correlated with change in PASI score (P=.024) up to 5.9 μg/mL.
  • Optimal responders (PASI≤2) had higher ustekinumab concentration compared with suboptimal responders (PASI>2; 4.0 vs 2.8 μg/mL; P=.036).
  • An ustekinumab concentration threshold of 3.6 μg/mL was associated with optimal response (area under the curve, 0.71; sensitivity, 86%; specificity, 63%; P=.036).
  • 1 patient (2%) was positive for anti-ustekinumab antibodies.
  • Psoriatic arthritis was associated with higher ustekinumab concentration in multivariate analysis (P=.048).

Study design

  • 49 patients with moderate to severe psoriasis treated with ustekinumab were included.
  • Funding: Research Foundation-Flanders, Belgium.

Limitations

  • Small patient sample size.
  • Cross-sectional study.

References


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