Safety of Cortisone Injections While Taking Ilumya (Tildrakizumab)
Cortisone injections are generally safe to receive while on Ilumya (tildrakizumab) therapy, as there are no specific contraindications or drug interactions between these treatments.
Understanding Ilumya (Tildrakizumab)
Ilumya is an interleukin-23p19 inhibitor approved for the treatment of moderate-to-severe plaque psoriasis 1. It works by targeting a specific pathway in the immune system that contributes to psoriatic inflammation.
Key characteristics of Ilumya:
- Administered subcutaneously at a dose of 100 mg initially, at week 4, and then every 12 weeks thereafter 1
- Has demonstrated a favorable safety profile in clinical trials with low rates of serious adverse events 2
- Does not appear to significantly increase infection risk compared to placebo in clinical trials 2
Safety Considerations for Cortisone Injections with Ilumya
Immunosuppression Concerns
- Ilumya is considered a selective immunosuppressant that targets the IL-23 pathway
- Unlike TNF inhibitors or IL-17 blockers, IL-23 inhibitors like Ilumya appear to have minimal impact on vaccine-induced immunity when used alone 1
- The guidelines suggest that IL-17 antagonists (which are in a similar therapeutic class) do not require specific dose reduction or timing adjustments around procedures 1
Timing Considerations
- There are no specific recommendations to delay or adjust timing of cortisone injections while on Ilumya
- Unlike medications such as methotrexate or rituximab, there are no recommendations to withhold Ilumya before or after procedures 1
Infection Risk
- Cortisone injections carry a small risk of infection at the injection site 3
- Safety data from pooled analysis of three randomized controlled trials showed that tildrakizumab had low rates of infections, with Candida skin infections occurring at a frequency of only 0.3% for the 100 mg dose 2
- The combined immunosuppressive effect appears minimal, as severe infections were rare (0.0-0.3%) in clinical trials of tildrakizumab 2
Potential Side Effects to Monitor
When receiving a cortisone injection while on Ilumya, be aware of these potential side effects:
Local effects of cortisone:
- Post-injection flare (temporary pain 24-48 hours after injection)
- Skin hypopigmentation or atrophy at injection site
- Potential acceleration of osteoarthritis progression with repeated injections 3
Systemic effects to monitor:
- Facial flushing
- Temporary hyperglycemia (especially important for diabetic patients)
- Potential adrenal suppression with frequent injections 3
Special Considerations
Timing After Injection
- If planning joint replacement surgery, cortisone injections should be avoided within 2-4 weeks before the procedure due to increased infection risk 4
- For routine cortisone injections without planned surgery, no specific waiting period is required
Dosing Considerations
- For patients on prednisone >10 mg daily (or equivalent), the immune response may be somewhat impaired 1
- Consider using the lowest effective dose of cortisone for the injection
Conclusion
Based on current evidence, receiving a cortisone injection while taking Ilumya appears to be safe with no specific contraindications or required timing adjustments. The selective nature of Ilumya's immunosuppression and its favorable safety profile suggest minimal additive immunosuppressive effects when combined with localized cortisone injections.
Monitor for standard side effects of cortisone injections, including temporary pain flare, skin changes at the injection site, and potential systemic effects like temporary blood glucose elevation.