Skyrizi vs. Otezla for Plaque Psoriasis and Psoriatic Arthritis: Important Differences and Potential Risks.

Key takeaways

Skyrizi (risankizumab) and Otezla (apremilast) are both used to treat psoriasis and psoriatic arthritis, but they work differently and are taken in different ways. Skyrizi is an interleukin antagonist given as an injection, while Otezla is a PDE-4 inhibitor taken by mouth. Skyrizi is a biological medication made from living cells, whereas Otezla is not a biologic and has a generic version that is FDA-approved but not yet available. Skyrizi is typically administered every 2 to 3 months after initial doses, but Otezla requires a daily dosing schedule that starts low and gradually increases to reduce side effects like nausea and diarrhea. Skyrizi can weaken your immune system and increase the risk of infections. Otezla is less likely to cause serious infections but can lead to weight loss and depression. Both medications have their own set of common side effects, with Skyrizi often causing joint pain and Otezla frequently leading to gastrointestinal issues.

Skyrizi

(risankizumab)

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Otezla

(apremilast)

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Summary for Skyrizi

Prescription only

Skyrizi (risankizumab or risankizumab-rzaa) is an injection used to treat different inflammatory conditions in adults. This includes plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. It belongs to the drug class called interleukin antagonists. It works to lower inflammation and relieve symptoms. After the first few doses, you usually get the Skyrizi (risankizumab) injection every 2 or 3 months. This medication can raise your risk of infection as a side effect.

Indications for Skyrizi

Moderate-to-severe plaque psoriasis in adults
Psoriatic arthritis in adults
Moderate-to-severe Crohn's disease in adults
Moderate-to-severe ulcerative colitis in adults

Pros and Cons for Skyrizi

Pros

Given every 2 or 3 months after a couple of starter doses (depends on your condition)
Can give injections under the skin at home after you get trained

Cons

Must be given as an injection
Not approved for children

Common Side Effects for Skyrizi

Upper respiratory infections (13%)
Headache (4%)
Tiredness (3%)

Warnings for Skyrizi

Allergic reaction
Risk of infection
Rare case of liver injury
Caution when getting vaccines

Summary for Otezla

Prescription only

Otezla (apremilast) is a tablet that's taken by mouth. It treats plaque psoriasis and psoriatic arthritis in people 6 years and older. The medication can also treat mouth sores from Behçet’s disease in adults. It works as a phosphodiesterase-4 (PDE4) inhibitor to reduce inflammation. Immediate-release tablets called Otezla are taken twice daily. You start at a low dose, then it gets raised over a few days to a maintenance dose. Some people can switch to once-daily, extended-release tablets called Otezla XR. Side effects include nausea and diarrhea.

Indications for Otezla

Psoriatic arthritis in people 6 years and older
Plaque psoriasis in people 6 years and older
Mouth sores from Behçet’s disease in adults

Pros and Cons for Otezla

Pros

Taken by mouth
Can take with or without food
Option to switch to once-daily extended-release tablets for some people

Cons

Dosing schedule can be confusing in the beginning
Common to have nausea or diarrhea when starting
Might not be a good option for people who've had depression or suicidal behavior