Key takeaways:
Skyrizi and Stelara are biologic medications for treatment of moderate-to-severe plaque psoriasis. Data suggests that Skyrizi is more effective than Stelara, but results vary by person.
There are no biosimilar options for Skyrizi, but several for Stelara are available.
Patients can save on Skyrizi and Stelara by using manufacturer savings cards and patient assistance programs.
Skyrizi (risankizumab-rzaa) and Stelara (ustekinumab) are commonly prescribed biologics for moderate-to-severe plaque psoriasis. Even if you regularly prescribe these medications, it may be helpful to have a quick comparison. They have similar safety profiles, but efficacy data from clinical trials give Skyrizi a slight edge. Cost and access are important, too.
Here we’ll give you an overview of these two medications, including a dosing comparison chart and ways your patients can save on medication costs.
Indications
Skyrizi is an IL-23 antagonist that is FDA approved to treat moderate-to-severe psoriasis in adults. Stelara is an IL-12/23 antagonist that can treat moderate-to-severe psoriasis in people ages 6 years and older.
In addition to psoriasis, both medications are also approved to treat:
Psoriatic arthritis
Crohn's disease
Ulcerative colitis
Administration
The chart below indicates dosing of each medication for treatment of plaque psoriasis:
| Skyrizi | Stelara | |
|---|---|---|
| Dosage form | Prefilled single-dose injection pen
Prefilled single-dose syringe
|
Prefilled single-dose syringe
Single-dose vial
|
| Adult dosing | Loading dose: 2 injections 4 weeks apart Maintenance dosing: Q12W |
Loading dose: 2 injections 4 weeks apart
Maintenance dosing: Q12W Weight-based dosing for loading dose and maintenance:
|
| Pediatric dosing | N/A | Loading dose: 2 injections 4 weeks apart
Maintenance dosing: Q12W
|
Efficacy
Skyrizi efficacy
Skyrizi’s efficacy data come from the “ultlMMa-1” and “ultlMMa-2” studies. These clinical trials helped contribute to Skyrizi's approval to treat psoriasis. In these studies, Skyrizi was compared to Stelara and placebo.
After 4 months, about 75% of people in either study receiving Skyrizi achieved 90% improvement in the Psoriasis Area Severity Index (PASI 90). 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 efficacy
The bulk of Stelara’s efficacy data for psoriasis comes from the “PHOENIX 1” and intention-to-treat “PHOENIX 2” clinical trials. Both studies were placebo-controlled and included adults with moderate-to-severe psoriasis. After 12 weeks, 67% of people receiving Stelara achieved PASI 75 in PHOENIX 1. In PHOENIX 2, 67% of patients receiving ustekinumab 45 mg and 76% of patients receiving 90 mg achieved PASI 75.
Children ages 6 through 11 with moderate-to-severe plaque psoriasis had similar results in another phase 3 study. After 12 weeks, 84% achieved PASI 75 and 64% achieved PASI 90 response. Older adolescents and teens had similar results in a separate study.
Safety profile
Neither Skyrizi nor Stelara have boxed warnings. The only contraindication is a history of serious hypersensitivity reaction to the ingredients.
Common side effects
Skyrizi and Stelara share similar side effects. In clinical studies of people taking these medications for plaque psoriasis, common side effects included:
Injection site reactions
Upper respiratory tract infections
Headache
Fatigue
Tinea infections (Skyrizi only)
Serious side effects
Clinical studies and postmarketing surveillance indicate the possibility of serious hypersensitivity reactions and serious infections for both medications. It’s also important to avoid live vaccines.
With Stelara, there is a theoretical risk for individuals genetically deficient in IL-12/IL-23 to be vulnerable to disseminated infections from mycobacteria and salmonella. Stelara may also raise the risk of malignancy, including squamous cell carcinoma. There have been two cases of posterior reversible encephalopathy syndrome (PRES) with Stelara.
Ways to save
Skyrizi and Stelara are available as reference (brand-name) biologics. But there are ways to help patients save money on their prescription costs.
Skyrizi savings
AbbVie offers several support solutions to help reduce out-of-pocket costs:
Copay assistance: Those with commercial insurance may be eligible to pay as little as $0 per dose using the Skyrizi Complete savings card. People with Medicare, Medicaid, or Tricare, or who rely on a state patient assistance program are not eligible.
Rebate assistance: If a pharmacy is unable to process the copay card when your patient is filling their prescription, they may be able to save with a prescription rebate. Just be sure to tell your patients to hold onto all receipts and pharmacy labels, as they’ll need to submit them for reimbursement.
Patient assistance: The myAbbVie Assist program helps people living in the U.S., including U.S. territories, receive free Skyrizi if they have limited insurance or no insurance. This program has income requirements.
There are no biosimilar options currently for Skyrizi.
Stelara savings
Johnson & Johnson offers these programs to help consumers with out-of-pocket costs:
Copay assistance: Eligible people with private or commercial health insurance may be able to pay as little as $5 per dose through the Stelara With Me savings program. People covered by Medicare, Medicaid, or another government program do not qualify.
Rebate assistance: Those whose pharmacies are unable to process the copay card may be able to get a Stelara rebate for out-of-pocket spending. Eligible patients should receive a rebate check about 3 weeks after submitting the form.
Patient assistance: Those who are uninsured, and those with insurance who can’t afford Stelara, may qualify for the Johnson & Johnson Patient Assistance Program, which provides medications at no cost for up to 1 year. This program has income requirements.
You can also consider prescribing a Stelara biosimilar. Several Stelara biosimilars have been approved since 2023, including these examples:
Imuldosa (ustekinumab-srlf)
Selarsdi (ustekinumab-aekn) — an interchangeable biosimilar for Stelara
Yesintek (ustekinumab-kfce) — an interchangeable biosimilar for Stelara
Wezlana (ustekinumab-auub) — an interchangeable biosimilar for Stelara
Otulfi (ustekinumab-aauz) — an interchangeable biosimilar for Stelara
Pyzchiva (ustekinumab-ttwe) — an interchangeable biosimilar for Stelara
Starjemza (ustekinumab-hmny) — an interchangeable biosimilar for Stelara
Steqeyma (ustekinumab-stba) — an interchangeable biosimilar for Stelara
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. Dosing for these subcutaneous injections vary, as well as efficacy data.
If cost is a concern, manufacturer savings cards, patient assistance programs, and Stelara biosimilars can help lower out-of-pocket costs.
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References
AbbVie, Inc. (2024). Skyrizi (risankizumab-rzaa) injection, for subcutaneous or intravenous use [package insert].
ClinicalTrials.gov. (2021). BI 655066 (risankizumab) compared to placebo and active comparator (ustekinumab) in patients with moderate to severe chronic plaque psoriasis. National Library of Medicine.
ClinicalTrials.gov. (2021). BI 655066 versus placebo & active comparator (ustekinumab) in patients with moderate to severe chronic plaque psoriasis. National Library of Medicine.
Gordon, K. B., et al. (2018). Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from two double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials. The Lancet.
Janssen Biotech, Inc. (2025). Stelara (ustekinumab) injection, for subcutaneous or intravenous use [package insert].
Landells, I., et al. (2015). Ustekinumab in adolescent patients age 12 to 17 years with moderate-to-severe plaque psoriasis: Results of the randomized phase 3 CADMUS study. Journal of American Academy of Dermatology.
Leonardi, C. L., et al. (2008). Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). The Lancet.
Papp, K. A., et al. (2008). Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). The Lancet.
Phillip, S., et al. (2020). Ustekinumab for the treatment of moderate‐to‐severe plaque psoriasis in paediatric patients (≥ 6 to < 12 years of age): efficacy, safety, pharmacokinetic and biomarker results from the open‐label CADMUS Jr study. British Journal of Dermatology.
