Skyrizi vs. Stelara for Psoriasis: A Complete Guide to Effectiveness, Dosages, Side Effects, and More
Key takeaways:
Skyrizi (risankizumab-rzaa) and Stelara (ustekinumab) are injectable medications that treat psoriasis. Psoriasis is an autoimmune disorder that causes itchy, red, and painful skin patches.
Skyrizi and Stelara are beneficial medications for moderate-to-severe psoriasis. Some data suggests that Skyrizi is more effective than Stelara, but results vary by person. Your prescriber can tell you if one medication would likely be better for you than the other.
There are ways to save on Skyrizi and Stelara. If you’re eligible, manufacturer savings cards can help make your prescription more affordable. Patient assistance programs are also available.
Table of contents
Psoriasis is an autoimmune disorder. It’s a bothersome health condition that can cause your skin cells to grow faster than usual. This can lead to itchy, red, and painful spots anywhere on your body.
These types of symptoms can quickly make you consider what your treatment options are. Today, many medications are available that can help manage psoriasis symptoms. They can also improve your skin's appearance.
Of these, two common choices are Skyrizi (risankizumab-rzaa) and Stelara (ustekinumab). They both fight inflammation from psoriasis, but they’re each unique treatment options. In this article, we'll discuss how Skyrizi and Stelara compare to each other for psoriasis.
Skyrizi and Stelara overview
Skyrizi and Stelara are injectable, prescription-only medications. They’re both biologics, meaning they’re made from natural sources like proteins, cells, and tissues.
Skyrizi is FDA approved to treat moderate-to-severe psoriasis in adults, whereas Stelara can treat moderate-to-severe psoriasis in people ages 6 years and older.
Topical treatments, oral medications, and light therapy are often recommended as first-choice treatment options for psoriasis. But some people may not have enough improvement with them on their own. Or, you may experience some bothersome side effects. This is where biologics, such as Skyrizi or Stelara, may come in.
Psoriasis treatments: There are many ways to manage psoriasis, from medicated creams and pills to injections and light therapy.
Upcoming psoriasis treatments: Many potential psoriasis medications are making their way through clinical trials. If you’re looking for a new-and-improved treatment, check out what’s on the horizon.
Common psoriasis triggers: From alcohol to medications, learn the most common triggers for a psoriasis flare-up.
Psoriasis on darker skin: See pictures of what psoriasis looks like on darker skin tones.
In addition to psoriasis, both medications are also approved to treat:
Psoriatic arthritis (PsA)
Crohn's disease (CD)
Ulcerative colitis (UC)
Skyrizi vs. Stelara for psoriasis: Benefits and logistics
For most people, two of the main things to consider when choosing a medication are how well it works and how convenient it is to use. Here’s a breakdown for Skyrizi and Stelara.
Skyrizi effectiveness
What we know about Skyrizi's effectiveness comes from the "ultlMMa-1" and "ultlMMa-2" studies. These clinical trials helped contribute to Skyrizi's approval to treat psoriasis.
Both ultlMMa-1 and ultlMMa-2 studied people with moderate-to-severe psoriasis. In these studies, Skyrizi was compared to Stelara and placebo (an injection with no medication in it).
After 4 months, about 75% of people in either study receiving Skyrizi achieved 90% clearer skin. In both studies, about 90% of people receiving Skyrizi continued to have 90% clearer skin through 1 year. These results were significantly better than both Stelara and placebo.
Stelara effectiveness
The bulk of Stelara's effectiveness data for psoriasis comes from the "PHOENIX 1" and "PHOENIX 2" clinical trials. Both studies included adults with moderate-to-severe psoriasis. Stelara was compared to placebo in both studies. After 12 weeks (about 3 months), a significantly higher number of people in either trial receiving Stelara saw 75% clearer skin.
Children ages 6 through 11 with moderate-to-severe plaque psoriasis had similar results in another phase 3 study. After 12 weeks, more than 75% had clear or almost clear skin, and over 80% saw at least 75% improvement in their symptoms. Older adolescents and teens had similar results in a separate study.
Dosages and administration
Skyrizi and Stelara are both given as subcutaneous (under the skin) injections. But they're supplied and administered differently.
Skyrizi is available as a prefilled single-use syringe or pen. The typical Skyrizi dosage is 150 mg per injection. You'll get your first two doses 1 month (4 weeks) apart. After these two doses, it's given once every 3 months (12 weeks).
Stelara is available as a prefilled single-use syringe or single-use vial. The recommended Stelara dosage depends on your body weight. For people weighing less than 100 kg (220 lbs), it's recommended to use 45 mg injections. After getting your first dose of Stelara, you'll get a second injection 1 month (4 weeks) later. After these initial two injections, it’s given once every 3 months (12 weeks). For people weighing 100 kg or more, you’ll follow the same timeline, but you’ll get 90 mg each time.
You can administer both Skyrizi and Stelara on your own at home. If you decide to give yourself the injection, it's best to alternate where you inject each dose. You can switch between your stomach or the tops of your thighs. If you inject Skyrizi or Stelara in your stomach, make sure it’s at least 2 inches away from your belly button. And if someone else is giving you the injection, they can administer it in the back of your upper arm.
Skyrizi mechanism of action
Skyrizi is an IL-23 antagonist. This means it works by blocking a cytokine (protein) in your body called interleukin-23 (IL-23). IL-23 is naturally present in your body, but a larger than normal amount is found in people with psoriasis. Too much IL-23 causes inflammation.
Stelara mechanism of action
Stelara is an IL-12/23 antagonist. Like Skyrizi, Stelara blocks IL-23. But it also blocks another cytokine, called interleukin-12 (IL-12). Like IL-23, IL-12 is naturally present in your body, but both are found in larger than normal amounts in people with psoriasis. By blocking IL-12 and IL-23, Stelara can help lower the inflammation that causes psoriasis symptoms.
Skyrizi vs. Stelara for psoriasis: Side effects and interactions
Every medication has drawbacks. Side effects and interactions can sometimes play a role in choosing what medication may work best for you.
Common side effects
Skyrizi and Stelara share similar side effects. Since they’re both injectable medications, they can cause reactions near the injection site, such as pain, redness, and swelling. Other side effects are also relatively mild, such as:
Upper respiratory tract infections
Headache
Fatigue
Stomach pain
Urinary tract infections
Other side effects have also been reported with Stelara, including diarrhea, back pain, and dizziness. But fungal infections, such as athlete's foot or ringworm, that may occur with Skyrizi haven’t been reported with Stelara.
Serious side effects
Although rare, people taking Skyrizi or Stelara have a higher risk of developing serious infections. Examples include:
Skin infections, such as cellulitis
Bone infections, such as osteomyelitis
Blood infections, such as septicemia or sepsis
Other serious risks that have been reported in clinical trials include allergic reactions, such as skin rash, hives, or facial swelling. Tuberculosis (TB) reactivation is also possible — this is when a latent TB infection becomes active again.
Stelara may also raise the risk of certain types of cancer, especially skin cancer. You should let your healthcare professional know if you have a history of skin cancer before starting Stelara.
Interactions
The main thing to avoid with Skyrizi and Stelara are live vaccines. This is because Skyrizi and Stelara can weaken the immune system. People with weakened immune systems should avoid live vaccines to prevent accidental infection.
Examples of live vaccines include Varivax (chickenpox vaccine) and FluMist (a flu vaccine that's sprayed in the nose). The inactivated flu vaccines — which are the flu vaccines that are injected into a muscle — aren’t live vaccines. You can receive those if you’re prescribed Skyrizi or Stelara.
Other interactions are also possible, such as with immunosuppressants and other biologics. Make sure your entire care team has a full list of medications and supplements you take. This helps prevent potential interactions.
How to save on Skyrizi and Stelara
Skyrizi and Stelara are available as reference (brand-name) medications. GoodRx can help you navigate ways to save on your prescription.
Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Skyrizi’s price is as little as $0 per dose if you use the manufacturer’s savings card. Stelara’s price is as little as $5 if you use the manufacturer’s savings card.
Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for the Skyrizi or Stelara patient assistance programs, which offer the medications at no charge.
You can also save with a Stelara biosimilar. Biosimilars are somewhat like generic versions of brand-name biologics. Several Stelara biosimilars have been approved since 2023, and they’re now commercially available. Talk to your prescriber if you’re interested in receiving a biosimilar to Stelara.
Frequently asked questions
Skyrizi (and Stelara) don’t completely stop inflammation. But they both significantly reduce it by targeting specific proteins in the immune system. Skyrizi blocks interleukin-23 (IL-23), while Stelara blocks both IL-12 and IL-23. By calming overactive immune responses, these medications can reduce symptoms and prevent flare-ups.
You should avoid live vaccines while you’re receiving Stelara (or Skyrizi); they may not be safe with a weakened immune system. When possible, it’s also important to limit exposure to people who are sick since these medications can make it harder for your body to fight infections. Certain medications that affect the immune system, including other biologics or immunosuppressants, should only be used if a healthcare professional recommends them.
No, you shouldn't combine Skyrizi and Stelara. Taking them together may worsen side effects. More studies are needed to recommend a combination of Stelara with medications like Skyrizi.
The bottom line
Skyrizi (risankizumab-rzaa) and Stelara (ustekinumab) are biologic medications that are FDA approved to treat moderate-to-severe psoriasis, among other conditions. Both are given as under-the-skin injections every few months and can significantly improve skin symptoms. But they also have some differences. For instance, Stelara is approved for kids, while some studies suggest that Skyrizi is more effective overall.
If cost is a concern, manufacturer savings cards and Stelara biosimilars can help lower out-of-pocket costs. And like many biologics, both medications can increase the risk of infection and other side effects. It’s important to discuss your health history with your prescriber before starting either one.
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References
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