How Skyrizi and Stelara Work for Plaque Psoriasis
Skyrizi (risankizumab) targets only interleukin-23 (IL-23), a protein driving inflammation in psoriasis.[1] Stelara (ustekinumab) blocks both IL-12 and IL-23 by binding to their shared p40 subunit, addressing a broader inflammatory pathway.[1][2]
Clinical Effectiveness Head-to-Head
In head-to-head trials like STEP 1 and STEP 2, Skyrizi showed superior skin clearance. At week 52, 76% of Skyrizi patients achieved PASI 90 (90% improvement) versus 48% on Stelara; PASI 100 rates were 57% versus 29%.[3] Both clear plaques effectively, but Skyrizi maintains higher response rates longer-term.[3]
Dosing Schedules and Administration
Skyrizi requires two 150 mg subcutaneous injections at week 0, then every 12 weeks.[1] Stelara starts with doses at weeks 0 and 4 (45 or 90 mg based on weight), then every 12 weeks.[2] Skyrizi skips the second loading dose, making early maintenance simpler.
Common Side Effects Patients Report
Both have low serious infection risks. Skyrizi's top issues include upper respiratory infections (14%), headache (6%), and fatigue (4%); serious events occur in under 2%.[1] Stelara lists nasopharyngitis (11%), headache (5%), and injection site reactions (4%); it carries a black box warning for infections and malignancy.[2] Skyrizi reports fewer injection reactions.
Cost and Insurance Coverage Differences
Skyrizi's annual wholesale cost exceeds $60,000, similar to Stelara's $50,000-$70,000 range, but copays vary by plan. Patient assistance programs exist for both; Skyrizi often has lower out-of-pocket via AbbVie's myAbbVie Assist.[4]
Which Is Approved for More Conditions?
Stelara treats plaque psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis, and pediatric psoriasis.[2] Skyrizi covers plaque psoriasis, psoriatic arthritis, and Crohn's, but not ulcerative colitis or pediatrics yet.[1]
When Do Patents Expire?
Skyrizi's key patents run through 2033-2037; Stelara's composition patent expired in 2023, with biosimilars launching in 2025 amid ongoing litigation.[5]DrugPatentWatch.com
[1] Skyrizi Prescribing Information, AbbVie, 2023.
[2] Stelara Prescribing Information, Janssen, 2023.
[3] Reich K et al., Lancet 2020;395:1945-56 (STEP trials).
[4] GoodRx pricing data, 2024.
[5] DrugPatentWatch.com, risankizumab/ustekinumab patents, accessed 2024.