Does Skyrizi Cause Fatigue?
Skyrizi (risankizumab-rzaa), an IL-23 inhibitor for psoriasis, Crohn's disease, and ulcerative colitis, lists fatigue as a possible side effect in its prescribing information. Clinical trials reported fatigue in 1-2% of patients, higher than placebo rates of less than 1%.[1] Post-marketing reports and patient forums note it as an occasional complaint, though it's not among the most common effects like upper respiratory infections.
How Common Is Fatigue with Skyrizi?
In pivotal trials (e.g., IMMvent for psoriasis), fatigue occurred in 1.7% of Skyrizi users versus 0.7% on placebo. For Crohn's (ADVANCE/FORTIFY trials), it was around 2%, still low incidence. Real-world data from FAERS (FDA Adverse Event Reporting System) shows fatigue reports, but causality isn't always confirmed—many patients have underlying conditions like autoimmune diseases that independently cause tiredness.[1][2]
Why Might Skyrizi Cause Fatigue?
The mechanism isn't fully established, but IL-23 inhibition can affect immune responses, potentially leading to transient energy dips during initial dosing or flares. Infections, a more frequent side effect (13-20%), could indirectly contribute via malaise. Some patients report it resolving after the first few infusions or injections.[3]
What Do Patients Say About Fatigue on Skyrizi?
User reviews on Drugs.com and WebMD mention fatigue in 10-15% of comments, often mild and short-lived (e.g., "Felt wiped out first week, then fine"). Reddit threads (r/Psoriasis, r/CrohnsDisease) describe it as less severe than with biologics like Humira or Stelara, but some switch due to persistent tiredness.[4]
How Does Fatigue on Skyrizi Compare to Other Biologics?
| Drug | Fatigue Rate in Trials | Notes |
|------|-------------------------|-------|
| Skyrizi | 1-2% | Lower than average |
| Stelara (ustekinumab) | 3-5% | Similar IL pathway, slightly higher |
| Tremfya (guselkumab) | 1-3% | Closest competitor, comparable |
| Humira (adalimumab) | 5-7% | TNF inhibitor, more common |
| Cosentyx (secukinumab) | 2-4% | IL-17 inhibitor, moderate |
Skyrizi generally has lower fatigue reports, making it a switch option for those fatigued on TNFs.[1][5]
When Does Fatigue Typically Happen and How Long Does It Last?
Most cases emerge in the first 4-12 weeks, peaking after loading doses. It often fades within days to weeks as the body adjusts. If persistent beyond 3 months, doctors check for anemia, infections, or disease activity rather than blaming the drug alone.[3]
What If Fatigue Persists—What Should You Do?
Consult your doctor; they may test for thyroid issues, vitamin D deficiency, or sleep apnea, common in these patients. Dose adjustments or pausing aren't standard, but switching biologics happens in 5-10% of cases. No black-box warnings tie Skyrizi directly to severe fatigue.[1][2]
[1]: Skyrizi Prescribing Information, AbbVie (https://www.skyrizi.com/content/dam/skyrizi/pdfs/SKYRIZI-PI.pdf)
[2]: FDA FAERS Database (https://www.fda.gov/drugs/questions-and-answers-fdas-adverse-event-reporting-system-faers/fda-adverse-event-reporting-system-faers-latest-quarterly-data-files)
[3]: Clinical Pharmacology Review, FDA Approval Package (https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/761061Orig1s000TOC.cfm)
[4]: Drugs.com Skyrizi Reviews (https://www.drugs.com/comments/risankizumab/skyrizi.html)
[5]: Head-to-Head Biologic Comparisons, Journal of the American Academy of Dermatology (2023)