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Correspondence |

Cutaneous Infarction Under IL-12/23 p40 Inhibition: A Cautionary Note

Dan Lipsker, MD, PhD; Virginie Lutz, MD
Arch Dermatol. 2011;147(11):1344-1345. doi:10.1001/archdermatol.2011.318.
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Ustekinumab is a human monoclonal antibody developed by Centocor (now Janssen Biotech Inc, Horsham, Pennsylvania), that binds to the shared p40 protein subunit of human interleukin (IL)-12 and IL-23, thereby preventing interaction with their cell surface IL-12R β1 receptor. This leads to a downregulation of interferon- γ and IL-17 synthesis. It is approved in Europe and the United States for the treatment of psoriasis. The PHOENIX 11 and PHOENIX 22 studies that led to approval of the drug showed a correct safety profile, though some statistically nonsignificant serious cardiovascular adverse effects were observed more frequently in patients treated with ustekinumab than in patients in the placebo group.1,3 An earlier study already pointed to a potential excessive risk of myocardial infarction,2 especially in the high-dose group.

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Figure. Necrotic purpura in a patient with psoriasis treated with ustekinumab.

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