How does tremfya compare to skyrizi?

How do Tremfya and Skyrizi work?

Tremfya (guselkumab) targets IL-23, a cytokine driving inflammation in psoriasis and related conditions. Skyrizi (risankizumab) also blocks IL-23 but binds a different epitope, potentially offering tighter inhibition in some studies.[1][2]

What conditions do they treat?

Both are FDA-approved for moderate-to-severe plaque psoriasis in adults. Tremfya additionally treats active psoriatic arthritis (PsA), while Skyrizi covers PsA, Crohn's disease, and ulcerative colitis.[3]

| Condition | Tremfya | Skyrizi |
|-----------|---------|---------|
| Plaque Psoriasis | Yes | Yes |
| Psoriatic Arthritis | Yes | Yes |
| Crohn's Disease | No | Yes |
| Ulcerative Colitis | No | Yes |

How effective are they for psoriasis?

In head-to-head trials like ECLIPSE, Tremfya showed slightly better skin clearance at week 48 (PASI 90: 80.5% vs. 72.9% for Skyrizi), though differences narrowed over time. Real-world data often shows similar PASI 75/90/100 rates around 80-90% at one year.[4][5] For PsA, both achieve ACR20/50 responses in 50-70% of patients.

Dosing and administration differences

Tremfya starts with a 100 mg subcutaneous injection at week 0, then every 8 weeks. Skyrizi uses 150 mg (two 75 mg injections) at weeks 0 and 4, then every 12 weeks. Skyrizi's longer interval means fewer annual doses (4 vs. 7).[6]

Common side effects and safety

Both carry black-box warnings for infections like tuberculosis. Upper respiratory infections affect 15-20% on either drug; serious infections are rare (<1%). Tremfya reports slightly higher rates of injection-site reactions (20% vs. 10-15%). No major malignancy signals in long-term data.[7]

Cost and access

List prices are similar: ~$6,500-7,000 per dose in the US, or $70,000-80,000 annually before rebates. Skyrizi often has stronger copay assistance, with patient out-of-pocket as low as $5/month. Insurance coverage favors both equally for psoriasis.[8]

Who makes them and when do patents expire?

Janssen (Johnson & Johnson) makes Tremfya; AbbVie produces Skyrizi. Key US patents expire in 2032-2033 for both, with biosimilar challenges already filed. No generics until then.[9]DrugPatentWatch.com

Which to choose?

Dermatologists often pick Skyrizi for its less frequent dosing and broader GI approvals, Tremfya for proven long-term skin superiority in some psoriasis patients. Guidelines recommend either first-line after TNF failures.[10]

Sources:
[1] FDA Label: Guselkumab
[2] FDA Label: Risankizumab
[3] American Academy of Dermatology Guidelines 2023
[4] Gordon et al., Lancet 2022 (ECLIPSE trial)
[5] Lebwohl et al., J Am Acad Dermatol 2023
[6] Prescribing Information (both)
[7] Post-marketing surveillance data, FDA FAERS
[8] IQVIA pricing data 2024
[9] DrugPatentWatch.com | DrugPatentWatch.com
[10] GRAPPA PsA Guidelines 2024