Can You Take Stelara and Skyrizi Together?
No, doctors do not recommend combining Stelara (ustekinumab) and Skyrizi (risankizumab). Both are biologic drugs that block interleukin-23 (IL-23), a key protein driving inflammation in conditions like psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. Using them together offers no added benefit and raises serious risks of infection, immune suppression, and other toxicities due to overlapping mechanisms.[1]
What Risks Come with Combining Them?
Dual IL-23 inhibition can weaken the immune system excessively, increasing chances of serious infections (e.g., tuberculosis reactivation), fungal infections, or malignancies. Clinical guidelines from the American College of Rheumatology and FDA labeling warn against concurrent biologics in the same class, as trials show higher adverse events without efficacy gains.[1][2] No studies support safe co-administration.
When Might a Doctor Switch Between Them?
Switches happen if one drug fails—Stelara is every 8-12 weeks via injection or IV; Skyrizi is every 12 weeks subcutaneously. Guidelines suggest a 4-8 week washout for Stelara before starting Skyrizi to clear the system, though exact timing varies by patient factors like disease severity.[3]
How Do Stelara and Skyrizi Compare Head-to-Head?
| Feature | Stelara (ustekinumab) | Skyrizi (risankizumab) |
|---------|-----------------------|------------------------|
| Targets | IL-12/IL-23 | IL-23 only |
| Approved for | Psoriasis, psoriatic arthritis, Crohn's, UC | Psoriasis, psoriatic arthritis, Crohn's |
| Dosing frequency | Every 8-12 weeks | Every 12 weeks |
| Efficacy in trials | 70-90% skin clearance (PASI 90) | 75-95% skin clearance (PASI 90), slightly faster onset |
| Common side effects | Upper respiratory infections, headache | Similar, plus fatigue |
Skyrizi edges out in some psoriasis trials for speed and skin clearance, but Stelara has broader approvals.[4]
What Do Patients and Doctors Say About Switching?
Patient forums report switches due to loss of response (common after 1-2 years on biologics). Rheumatologists often cycle IL-23 inhibitors before trying TNF blockers like Humira or JAK inhibitors like Rinvoq. Always consult your doctor—self-adjusting risks flares or complications.[5]
Alternatives if One Isn't Enough
- Other IL-23 drugs: Tremfya (guselkumab) or Ilumya (tildrakizumab).
- Different classes: Cosentyx (IL-17), Taltz (IL-17), or methotrexate add-ons.
- Combo therapy: Low-dose methotrexate with one biologic is sometimes used, but not two biologics.
Your doctor weighs liver function, infection history, and TB status before changes.
[1]: FDA Stelara Prescribing Information - https://www.accessdata.fda.gov/drugsatfdadocs/label/2023/761044s029lbl.pdf
[2]: FDA Skyrizi Prescribing Information - https://www.accessdata.fda.gov/drugsatfdadocs/label/2023/761225s029lbl.pdf
[3]: American Academy of Dermatology Guidelines on Biologic Therapy - https://www.aad.org/practicecenter/quality/clinical-guidelines/psoriasis
[4]: New England Journal of Medicine head-to-head trials (e.g., risankizumab vs. ustekinumab) - https://www.nejm.org/doi/full/10.1056/NEJMoa1812775
[5]: American College of Rheumatology Biologics Guidelines - https://rheumatology.org/psoriatic-arthritis-guideline