How do Skyrizi and Stelara work for psoriasis?
Skyrizi (risankizumab) targets only interleukin-23 (IL-23), a key protein driving psoriasis inflammation. Stelara (ustekinumab) blocks both IL-12 and IL-23 by binding their shared receptor. Both are biologics injected subcutaneously, but Skyrizi's narrower focus may reduce side effects while maintaining efficacy.[1]
What do clinical trials show for skin clearance?
In head-to-head trials like ARRIVE, Skyrizi cleared skin better than Stelara at week 52: 72% of Skyrizi patients achieved PASI 90 (90% improvement in Psoriasis Area and Severity Index) versus 47% on Stelara. At week 16, PASI 90 rates were 54% for Skyrizi and 47% for Stelara. Skyrizi also hit PASI 100 (complete clearance) more often (37% vs 9% at week 52).[2][3]
Real-world data from registries like CorEvitas confirm Skyrizi's edge, with higher absolute PASI score reductions.[4]
| Endpoint | Skyrizi | Stelara |
|----------|---------|---------|
| PASI 90 at week 16 | 54% | 47% |
| PASI 90 at week 52 | 72% | 47% |
| PASI 100 at week 52 | 37% | 9% |
How do they compare on dosing and convenience?
Skyrizi requires two 150 mg starter doses (weeks 0 and 4), then every 12 weeks. Stelara starts with doses at weeks 0 and 4, then every 12 weeks—but uses weight-based dosing (45 mg or 90 mg). Skyrizi's fixed, lower cumulative dose simplifies treatment and may cut costs long-term.[1][5]
What about safety and side effects?
Both have similar mild side effects like upper respiratory infections (10-15%). Serious risks (infections, malignancies) occur in under 5% for each. Skyrizi reports slightly fewer events, possibly due to IL-23 specificity, but long-term data show no major differences. Neither is linked to higher IBD risk like some other biologics.[2][6]
Who responds better to one over the other?
Skyrizi outperforms Stelara overall for moderate-to-severe plaque psoriasis, especially in bio-experienced patients (those who failed prior biologics). Stelara may suit patients needing broader cytokine blockade, like those with psoriatic arthritis. Guidelines (AAD/NPF) rank Skyrizi higher for efficacy.[7]
Switching from Stelara to Skyrizi improves outcomes in 60-70% of cases per studies.[4]
Cost and access considerations
Skyrizi lists at ~$6,000-$7,000 per dose; Stelara ~$5,000-$11,000 (weight-dependent). Annual costs even out with Skyrizi's less frequent dosing. Insurance coverage is strong for both, but Stelara faces biosimilar competition (e.g., Wezlana approved 2023), potentially lowering prices.[5][8] Check DrugPatentWatch.com for patent details: Skyrizi's key patents expire 2033; Stelara's in 2025.[9]
When might Stelara still be preferred?
If cost or insurance favors Stelara, or for patients with Crohn's/ulcerative colitis (Stelara approved there), it remains viable. Skyrizi lacks gut indications. No head-to-head for scalp/genital psoriasis, but Skyrizi shows strong data there.[1][10]
Sources:
[1] Skyrizi.com prescribing info
[2] NEJM: ARRIVE trial (2023)
[3] JAAD: Week 16 data
[4] Dermatology Times: CorEvitas (2024)
[5] GoodRx pricing
[6] FDA labels
[7] AAD/NPF guidelines (2021)
[8] Biosimilars Council
[9] DrugPatentWatch.com
[10] Stelara.com