What Is It Like to Take Skyrizi for IBD?
Key takeaways:
Skyrizi (risankizumab) is an injectable prescription medication used to treat inflammatory conditions, including inflammatory bowel disease (IBD).
To start treatment with Skyrizi, you receive the first three doses through an IV. After that, you give yourself regular doses at home using an on-body injector.
People who take Skyrizi tell GoodRx it’s convenient to inject at home, once you get the hang of it.
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Skyrizi (risankizumab) is a prescription medication given by infusion into a vein (IV) and by injection. It is used to treat inflammatory bowel disease (IBD) and other inflammatory conditions, such as psoriasis.
IBD affects the digestive system but can also cause problems in other parts of the body. One type of IBD is Crohn’s disease, which can cause symptoms anywhere in the digestive system. The other main form of IBD, ulcerative colitis, affects the large intestine (colon).
IBD can be managed with a combination of medications, surgery, and lifestyle changes. But there is no known cure. Skyrizi is FDA approved to treat Crohn’s, but it is not yet approved for treating other types of IBD, such as ulcerative colitis.
Below, three people describe what it’s like to take Skyrizi for IBD.
Biologic therapy was a little intimidating at first
Dewey Thom, a retired institutional stockbroker from San Francisco, was diagnosed with ulcerative colitis in the 1970s. He tried the only available medications at the time — low-dose prednisone and sulfasalazine — before having surgery 37 years ago to create a J-pouch (a procedure called an ileal pouch-anal anastomosis, or IPAA).
His problems with IBD continued even after surgery. He developed a stricture (narrowing) in the J-pouch and began having blockages, and the pouch became inflamed (called pouchitis). Dewey remembers his doctor saying that the stricture and the inflammation could actually be from Crohn’s disease and suggested a biologic medication.
Biologic medications, known as biologics or biologic therapy, come from living organisms like cells or tissues. They’re made using advanced biotechnological processes.
What are biologics?
Biologics for IBD work by targeting the immune system. They interfere with specific molecules to help control inflammation. Because of their complex nature, biologics are typically administered through injection or infusion. They are also often sensitive to temperature and require special handling.
Dewey says he cycled through multiple biologic medications but they all stopped working after a time.
Dewey was trying his third biologic and his stricture needed dilation (stretching) too often — meaning, every few months. So his doctor suggested he switch medications again.
“Being my fourth biologic, the transition was a little less intimidating because I already had to make the tough decision to switch medications three other times,” Dewey says.
After the three starter doses given by IV, Dewey began using a Skyrizi on-body injector at home. Even though it was a device that was new to him, he says that learning to use it wasn’t difficult.
“It’s a little intimidating,” he says. “It takes a little bit of getting used to, but I’ve done it twice — the second time almost without reading the directions.”
Dewey says watching instructional videos helped him figure out how to use the device. And he discovered that placing the body injector on his leg, rather than the abdomen, is easiest for him. Though, he cautions that people who have a lot of body hair might find removing the device from their leg uncomfortable.
“It’s strong adhesive,” he says. “It’s not going to just fall off.”
Dewey is cautiously optimistic about how he feels after starting treatment with Skyrizi. The frequent partial obstructions he had before starting the medication have improved. And getting insurance approval and the delivery of the medication are also going well. Because he lives in the city without a secure place to receive deliveries, Dewey has Skyrizi delivered to a local pharmacy, where he picks it up.
Dewey has a few pieces of advice for people with IBD who are starting treatment with Skyrizi. For one, he recommends getting doses delivered well before it’s time to take them.
“Usually, the pharmacy will want you to order it far in advance in case something goes wrong,” he says.
He also says that it’s good to know that Skyrizi comes in different doses and dosage forms, including an injector pen and a syringe. It’s important to know which dose and delivery method you’re prescribed, since Skyrizi is also given at a different dosage for psoriasis.
Once, Dewey discovered the order for his refill was made for a syringe when it should have been for the on-body injector. This caused confusion with his pharmacy that had to be cleared up to complete the order.
Mother of two was tired of being in the bathroom all the time
Erica Molina, a 39-year-old mother of two from Houston, was diagnosed with ulcerative colitis in 2019. She had symptoms that included bloody stools and the frequent need to use the bathroom for more than 2 years before finding out what was wrong.
“I went 2 years bleeding, just thinking I had hemorrhoids,” she says.
After her diagnosis, Erica’s doctor prescribed her biologic therapy.
After a few years of taking a biologic, Erica had a flare-up that she couldn’t get back under control. She and her care team were exhausting all the treatment options. But Erica’s disease is what’s called severe refractory ulcerative colitis. So, for reasons that are unclear, she was cycling through medications with no change in her symptoms.
Her doctors wanted her to start receiving two biologics at the same time, or what’s called combination therapy. It is not common to take two biologics at the same time for IBD. But Erica’s doctors decided it was the best way forward for her, “because there’s really nothing to go back to,” she says.
Erica is continuing treatment with the biologic she already takes and has now also started Skyrizi. Her doctor is prescribing her Sykrizi off-label, since the manufacturer is still waiting for FDA approval of the medication as a treatment for ulcerative colitis. After talking with her doctors and doing some research about Skyrizi, she felt comfortable about its safety. Still, she made sure to speak up when she went to the infusion center for her first dose. She asked about possible side effects, such as an allergic reaction, for example.
“When I got to the infusion center, I was actually worried about the severe allergic reaction part, because it’s not in the hospital,” she says. “But the nurses at the infusion center said they didn’t have a lot of patients that had bad reactions. So that helped calm me down.”
With other biologics, Erica received pre-meds (such as an antihistamine) before her initial infusions. (Pre-meds are sometimes given to manage pain or a potential allergic reaction.) But she hasn’t with Skyrizi. And, so far, everything has gone well.
Erica says that she has experienced extreme fatigue after the infusions, which is a side effect she hasn’t previously had with biologics.
“What I did feel? I was so tired. I was exhausted,” she says of receiving her first Skyrizi dose. “I couldn’t even keep my eyes open. When I came home that night, I was so tired.”
One reason why combination therapy isn’t often used as a treatment method is the expense. Insurance coverage was a worry for Erica, but it hasn’t turned out to be a problem.
“I thought we were gonna have a really big challenge with it, getting them to approve two biologics,” Erica says. “I thought it would take a long time to get it approved. And it really didn’t.”
Erica hasn’t noted any changes in her symptoms, yet. But she hopes that once she achieves remission, she can stop taking one of the biologics.
Having Crohn’s means long-term medication management
Jamie Pfundheller, a 37-year-old pediatric nurse from Madison, Wisconsin, has a permanent ileostomy because of Crohn’s disease. When she was diagnosed, her doctors classified her disease as moderate. She went through several different biologics, all of which eventually stopped working. And then, her disease became complicated by fistulas, which are abnormal tunnels between two organs.
The fistulas were affecting her quality of life. So her doctors recommended that she have surgery to remove her colon and place an ileostomy. And she now wears an appliance on her abdomen to collect stool.
Jamie was hoping to eventually be able to stop taking medication. But her doctor recommended she start treatment with Skyrizi soon after getting the ileostomy. Jamie recalls the explanation her nurse gave: “Jamie, you still need to be on medication. You still have Crohn’s.”
Getting insurance approval for Skyrizi and starting treatment weren’t difficult, she says. But she does want other people to know that the three IV loading doses can take a few hours from start to finish. The medication is not premade, so she had to wait while the staff prepared it. This is to make sure that none of the medication goes to waste. The actual infusion, though, did go quick.
“The best part, I would say, about Skyrizi is that it runs only over a half hour instead of an hour,” Jamie says.
Now that she’s finished the loading doses, Jamie injects her medication at home every 8 weeks. She applies the on-body injector to her abdomen.
“I basically see it as I’m giving myself an infusion in my house instead of going to a hospital and getting an IV,” she says.
It takes 5 minutes for the on-body injector to dispense the medication. And the device lets her know when it’s safe to be removed.
“It feels honestly like it’s shorter than 5 minutes, and then it just keeps beeping to take it off,” Jamie says.
What does the pharmacist say?
Stacia Woodcock, PharmD
Pharmacy Editor
Skyrizi (risankizumab) is an injectable biologic medication that treats psoriasis, psoriatic arthritis, and Crohn’s disease. The manufacturer of Skyrizi is also seeking FDA approval for ulcerative colitis treatment, but for now that’s considered an off-label use of the medication.
Your Skyrizi dosage will depend on what you’re using it for. For Crohn’s disease, you’ll start with three infusions into a vein, given 4 weeks apart. These infusions will be administered in a healthcare provider’s office or infusion center, and they usually take a few hours from start to finish.
Once you’ve completed the infusions, you’ll switch to injections under the skin that you can give yourself at home. This can feel overwhelming at first, but your provider will make sure you know how to do it safely before you do it on your own. And Skyrizi comes in an on-the-body injector for Crohn’s disease that makes the process even easier. You just put the medication inside, stick the device to your body, and press a button. You’ll need to keep Skyrizi in the refrigerator, but you can take out your dose and let it come to room temperature before you inject it. This helps make the injections less uncomfortable.
Headache and fatigue are common Skyrizi side effects. Infections, such as the common cold or urinary tract infections, are more likely while you’re taking Skyrizi. That’s because it works by lowering the activity of your immune system. This makes it harder for your body to fight off infections the way it normally would. So be sure to let your provider know if you have symptoms of an infection while taking Skyrizi. These might include a cough, fever, or pain when peeing.
Since it’s a biologic medication, you may need to use a specialty pharmacy to fill your Skyrizi prescription. This may mean that you receive the medication through the mail, which requires some advance planning. Your provider will help connect you with a specialty pharmacy that works for your needs.
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