What to Know About Skyrizi for Psoriatic Arthritis

If you or a loved one are living with psoriasis or psoriatic arthritis (PsA), you’re well aware how skin and joint problems can disrupt your daily routine. Psoriasis is an autoimmune disorder that causes red, scaly patches on your skin, while PsA is a condition that also causes joint pain and swelling (psoriasis plus arthritis).

Thankfully, many treatment options are available to manage these health conditions. Skyrizi (risankizumab-rzaa) is one of them. It’s an injectable medication that can improve quality of life for some adults with psoriasis and PsA. However, it’s a complex biologic that comes with potential risks as well as benefits — just like all medications.

What is Skyrizi used for?

Skyrizi is an injectable medication that’s used to manage moderate to severe psoriasis and active PsA in adults. 

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However, Skyrizi isn’t your average medication. It’s a type of a biologic medication. Biologics are complex drugs that are made from living and natural sources, such as bacteria, proteins, and tissues. It’s also a monoclonal antibody, which is a lab-made antibody (protein) that’s designed to attach to other proteins throughout your body. Biologic and monoclonal antibody medications, like Skyrizi, are often used to manage hard-to-treat health conditions.

Was Skyrizi initially approved for psoriatic arthritis?

No. Skyrizi was initially FDA approved in April 2019 for adults with moderate to severe psoriasis. Skyrizi’s approval for PsA followed a few years later. In January 2022, Skyrizi made headlines as a newly approved treatment option for PsA.

How does Skyrizi work for psoriatic arthritis?

Skyrizi is an IL-23 blocker. It works by blocking a protein in your body called interleukin-23 (IL-23).

IL-23 is naturally present in your body. But in psoriasis and PsA, there’s a larger than normal amount of it that’s causing inflammation. By blocking IL-23, Skyrizi decreases inflammation in the skin and joints, improving symptoms.

How is Skyrizi given when treating psoriatic arthritis?

Skyrizi is given as an injection under your skin. It’s available in two forms: a prefilled single-use syringe or pen.

It’s recommended to get one 150 mg injection the first time you take Skyrizi. After that, you’ll get another injection 1 month later. But after these initial two injections, you’ll get follow-up injections less frequently — usually about once every 3 months.

The good news? Skyrizi can be used at home. Your healthcare provider will show you how to use Skyrizi. If you decide to give yourself the injection, you can inject the medication in your stomach or the top of your thighs. If someone else is giving you the injection, the upper arms are an option, too.

Skyrizi may be prescribed alone or in combination with other disease-modifying antirheumatic drugs (DMARDs) like methotrexate.

What are the potential side effects of Skyrizi?

Like all medications, Skyrizi has a number of potential side effects. You should tell your healthcare provider about any side effects you experience.

Common side effects

The most common Skyrizi side effects are: 

• Upper respiratory tract infections (URIs)

• Headache

• Feeling tired

• Pain and swelling where Skyrizi was injected

• Tinea infections, such as athlete’s foot or ringworm

Serious side effects

Rare but serious side effects are also possible.

Because of its effects on the immune system, Skyrizi increases the risk of severe infections. Examples include:

• Tuberculosis (TB)

• Skin infections (such as cellulitis)

• Bone infections (such as osteomyelitis)

• Blood infections (such as sepsis)

• Shingles

While you’re receiving Skyrizi, your healthcare provider will monitor you closely for infections. As a precaution, you’ll also be screened for existing infections, such as TB, hepatitis B, hepatitis C, and HIV, before starting Skyrizi. And, your provider will discuss ensuring you’re up to date on all available vaccinations to decrease your infection risk.

Before you begin taking it, tell your healthcare provider if you are being treated for an infection or if you have symptoms of an infection (such as fever, chills, or cough). If you get sick and are due for your Skyrizi injection, your provider might advise you to wait until you’re feeling better to take your next dose.

Few people taking Skyrizi may also experience serious allergic reactions, like rash and facial swelling.

How effective is Skyrizi for treating psoriatic arthritis?

Most of what we know about Skyrizi’s effectiveness comes from the “KEEPsAKE-1” and “KEEPsAKE-2” studies. These are the key studies that helped contribute to Skyrizi’s approval to treat PsA.

• KEEPsAKE-1 studied more than 900 people with PsA who had responded poorly to (or couldn’t take) at least one nonbiologic DMARD (like methotrexate). In this study, Skyrizi was compared to placebo (an injection with no medication in it). 

• KEEPsAKE-2 studied about 440 people with PsA who had received one or two biologic medications in the past and/or at least one nonbiologic DMARD. In this study, Skyrizi was also compared to placebo.

After about 6 months, more than 50% of people in both studies had at least a 20% improvement in joint pain, stiffness, and swelling while receiving Skyrizi every 12 weeks. In both studies, more than 50% of these same people also experienced up to a 90% improvement in their psoriasis rashes. Both studies also showed an improvement in dactylitis (severe swelling of fingers or toes) and enthesitis (pain where tendons and ligaments connect to bones).

How to save on Skyrizi

There are ways to save on Skyrizi, which is only available as a reference (“brand-name”) medication. GoodRx can help you navigate between patient assistance programs and copay savings cards to save money on your prescription.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Skyrizi’s patient assistance program, which offers the medication free of cost.

• Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $5 for Skyrizi using a savings card from the manufacturer.

What are some alternatives to Skyrizi?

Skyrizi isn’t the only medication used to treat PsA. You and your healthcare provider will decide which PsA treatment is best for you based on your symptoms, other health conditions, personal preferences, and insurance status.

If you have more severe PsA, you’ll likely receive nonbiologic DMARDs like methotrexate and/or biologics like Skyrizi. Other biologics that treat PsA are:

• Cimzia (certolizumab pegol)

• Enbrel (etanercept)

• Humira (adalimumab)

• Orencia (abatacept)

• Remicade (infliximab)

• Simponi (golimumab)

• Stelara (ustekinumab)

• Taltz (ixekizumab)

• Tremfya (guselkumab) — this works the same way as Skyrizi

And if you want to avoid injections, oral tablet options are available, too. For instance, oral alternatives to Skyrizi include medications like Otezla (apremilast), Xeljanz (tofacitinib), and Rinvoq (upadacitinib).

Why trust our experts?

Written by:

Nikki Javit, PharmD

Nikki Javit, PharmD, is a clinical pharmacist with certifications in international travel medicine, immunization delivery, and pharmacogenomics. She received her bachelor’s of science in biology from Indiana University Bloomington and her doctor of pharmacy degree from Butler University.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

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