Tremfya
Tremfya (guselkumab) is an injection for adults with certain inflammatory conditions. It helps treat plaque psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's disease. Tremfya (guselkumab) is a monoclonal antibody known as an interleukin antagonist. It calms your immune system to lower inflammation. The dosing schedule is every 1 or 2 months, depending on your condition and how far along you are in treatment. Side effects are upper respiratory infections, headache, and injection site reactions. There's also a risk of other infections and liver problems as long-term side effects.
What is Tremfya (guselkumab)?
What is Tremfya (guselkumab) used for?
Moderate-to-severe plaque psoriasis
Active psoriatic arthritis
Moderate-to-severe ulcerative colitis (UC)
Moderate-to-severe Crohn's disease (CD)
How Tremfya (guselkumab) works
Tremfya (guselkumab) is a type of monoclonal antibody called an interleukin antagonist. It blocks a protein in your immune system called interleukin-23 (IL-23). This protein plays a role in causing inflammation in the body.
By blocking IL-23, Tremfya (guselkumab) helps lower inflammation in the body. It relieves symptoms of certain inflammatory conditions.
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What are the side effects of Tremfya (guselkumab)?
Common Side Effects
- Upper respiratory infections (14%)
- Headache (5%)
- Injection site reactions (5%)
- Joint pain (3%)
Other Side Effects
- Diarrhea
- Stomach flu
- Fungal infections
- Herpes infections
- Migraine
- Hives
- Higher liver enzyme levels
Serious Side Effects
- Severe allergic reactions: skin rash, hives, itching, swelling of face or tongue, trouble breathing, chest tightness
- Infections: fever, trouble breathing, cough that won't go away, night sweats, chills, muscle aches, feeling very tired, confusion, diarrhea
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Cough
- Diarrhea
- Headache
- Joint pain
- Pain, redness, or irritation at injection site
- Runny or stuffy nose
- Sore throat
Pros and cons of Tremfya (guselkumab)
Pros
An option for adults with plaque psoriasis who've already tried topical treatment
Given every 1 or 2 months (depending on your condition and treatment plan)
Few side effects
Can give yourself injections under the skin at home after you get trained
Cons
Given as an injection under the skin or injection through the vein
Raises the risk of infections
Can cause some injection site reactions
Can take several months to see the benefits of the medication
Pharmacist tips for Tremfya (guselkumab)
Tremfya (guselkumab) is a medication that's given as an injection. Most of the time, it's an injection under the skin. But if you have ulcerative colitis or Crohn's disease, you might start with infusions through a vein at a medical center. Then, you'll switch to the injections under the skin later.
Tremfya (guselkumab) is given every 4 or 8 weeks. Set reminders on your calendar or phone so you remember when your injection is.
For Tremfya (guselkumab) injections under the skin: The medication comes as a prefilled syringe, prefilled pen, or One-Press injector. You'll probably get your first dose at your prescriber's office. This is so they can show you how to inject it and make sure you can do it on your own.
For Tremfya (guselkumab) infusions through the vein: Plan ahead for some time at the medical center or clinic for your infusion. The infusion itself lasts at least 1 hour and you might have paperwork to fill out. Bring something to do, like a book to read, to pass the time.
Before getting any vaccines, tell the healthcare professional that you're taking Tremfya (guselkumab). They can make sure the vaccine is safe for you. Avoid live vaccines because the medication might raise your risk of getting sick from the vaccine itself.
Tell your prescriber if you're pregnant or planning on becoming pregnant. We don't fully know if Tremfya (guselkumab) is safe during pregnancy. Your prescriber can help you understand the risks and benefits. If you use Tremfya (guselkumab) while pregnant, you can join the pregnancy registry. This helps researchers learn more about how the medication affects pregnancy.
Tips on how to use and how to inject Tremfya (guselkumab) under the skin
Follow your care team's instructions on how to use and inject Tremfya (guselkumab) under the skin. Some of the steps are a little different for the prefilled syringe, pen, and One-Press injector. Read the Instructions for Use carefully. If you have questions, ask your prescriber or pharmacist.
How to store Tremfya (guselkumab): Keep the medication in the refrigerator until you're ready. Don't let it freeze. Keep it in the original box to protect it from light.
Before each Tremfya (guselkumab) injection: Take the medication out of the fridge. Let it sit for about 30 minutes so it reaches room temperature. Don't try to warm it up with your hands or any other way because it might damage the medication. Check the expiration date and make sure the liquid is clear to slightly yellow.
Wash your hands with soap and warm water before you inject Tremfya (guselkumab). Also, clean the area you've chosen for your injection with an alcohol swab and let it air dry. Inject the medication within 5 minutes of taking off the needle cover or cap.
Where to inject Tremfya (guselkumab): Inject the medication into the fatty part of your skin on the top of your thigh or belly (but stay 2 inches away from your belly button). With help, you can also inject it into the back of your upper arm. Don't inject into skin that's tender, red, hard, bruised, scaly, or has psoriasis.
After you inject Tremfya (guselkumab), you can cover the injection site with a bandage if you need to. Don't rub the area where you injected the medication.
How to throw away Tremfya (guselkumab): Right after your injection, put the used syringe, pen, or injector in a sharps container. Don't throw them away in the regular trash so no one gets hurt from needle sticks.
More on Tremfya (guselkumab) tips
Frequently asked questions about Tremfya (guselkumab)
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What are the risks and warnings for Tremfya (guselkumab)?
Tremfya (guselkumab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious allergic reactions
Some people have had serious allergic reactions after using Tremfya (guselkumab). This can sometimes include life-threatening anaphylaxis. Get medical help right away if you have an allergic reaction to the medication. Look out for trouble breathing, swelling in your face or mouth, skin rash, hives, or itching.
Risk of infections
Risk factors: Active, long-term, or frequent infection | Conditions that can raise your risk of infection | Taking other medications that can weaken your immune system
Tremfya (guselkumab) can affect your immune system and raise your risk of infections. This can include a wide range of bacterial, viral, or fungal infections. It can also include tuberculosis (TB). Serious infections are possible but usually aren't common.
Before starting Tremfya (guselkumab), tell your prescriber about your full medical history and any long-term infections you've had. This is especially important if you've had TB. Regardless, you'll get a TB test before treatment to check for this infection. If you have or had TB in the past, you'll need to take antibiotics to treat it or keep it from coming back. You shouldn't start Tremfya (guselkumab) until any active infections go away.
Be sure to wash your hands often with soap and warm water. And avoid close contact with those who are sick. Call your care team if you have any signs of an infection. Watch for fever, trouble breathing, a cough that won't go away, night sweats, or confusion. You might need to stop taking Tremfya (guselkumab) until you get better.
Liver damage
Risk factors: Liver problems
Some people had higher liver enzyme levels on their blood tests while taking Tremfya (guselkumab). This can be a sign of liver damage. Most cases were mild or moderate.
But one person with Crohn's disease had serious liver damage after taking higher-than-recommended doses of Tremfya (guselkumab). If you have Crohn's disease or ulcerative colitis, your prescriber will check how your liver is doing. They'll check before you start Tremfya (guselkumab), during at least 4 months of treatment, and every so often after that.
To be safe, watch for symptoms of liver damage. This includes belly pain, low appetite, tiredness, and yellow skin or eyes. Tell your care team right away if you notice any of these. If your tests or symptoms show liver damage, your prescriber might talk to you about other treatment options.
Interaction with vaccines
Before starting Tremfya (guselkumab), talk to your primary care provider about the vaccines you need. They'll help make sure you're up to date. If you need any vaccines while taking this medication, ask your prescriber or pharmacist if they're safe for you.
We don't fully know how Tremfya (guselkumab) affects vaccines. Since the medication affects the immune system, some vaccines might not work as well. You also might be at risk of infection from live vaccines, like MMR (measles, mumps, and rubella vaccine) and Varivax (varicella vaccine). It's best to avoid getting any live vaccines while taking this medication.
Tremfya (guselkumab) dosage forms
Typical dosing for Tremfya (guselkumab)
Plaque psoriasis or psoriatic arthritis
Week 0 (first day of treatment): The typical dose is 100 mg injected under the skin once.
*Week 4: The typical dose is 100 mg injected under the skin once.
Week 12 and beyond: The typical dose is 100 mg injected under the skin every 8 weeks.
Ulcerative colitis
Induction phase
Week 0 to 8: The typical dose is 200 mg infused into the vein every 4 weeks. It's given by a healthcare professional at a medical office or infusion clinic.
Maintenance phase (two options available)
Option 1 (week 16 and beyond): The typical dose is 100 mg injected under the skin every 8 weeks.
Option 2 (week 12 and beyond): The typical dose is 200 mg injected under the skin every 4 weeks.
Crohn's disease
Induction phase (two options available)
Option 1 (Weeks 0 to 8): The typical dose is 200 mg infused into the vein every 4 weeks. It's given by a healthcare professional at a medical office or infusion clinic.
Option 2 (Weeks 0 to 8): The typical dose is 400 mg injected under the skin every 4 weeks.
Maintenance phase (two options available)
Option 1 (week 16 and beyond): The typical dose is 100 mg injected under the skin every 8 weeks.
Option 2 (week 12 and beyond): The typical dose is 200 mg injected under the skin every 4 weeks.
How much does Tremfya (guselkumab) cost?
What are alternatives to Tremfya (guselkumab)?
Moderate-to-severe plaque psoriasis
Active psoriatic arthritis
Moderate-to-severe ulcerative colitis (UC)
Moderate-to-severe Crohn's disease (CD)
Moderate-to-severe plaque psoriasis (Ps) - adults and children 6 years and older
Psoriatic arthritis (PsA) - adults and children 6 years and older
Moderate-to-severe Crohn's disease (CD) - adults only
Moderate-to-severe ulcerative colitis (UC) - adults only
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
What is the latest news about Tremfya (guselkumab)?
Tremfya (guselkumab) images
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References
Best studies we foundGalluzzo, M., et al. (2023). Guselkumab for treatment of moderate-to-severe plaque psoriasis: Real-life effectiveness and drug-survival for up to 148 weeks. Expert Opinion on Biological Therapy.
Janssen Biotech, Inc. (2025). Instructions for Use: Tremfya® (trem fye’ a) (guselkumab) prefilled syringe.
Janssen Biotech, Inc. (2025). Tremfya- guselkumab injection; Tremfya- guselkumab injection [package insert]. DailyMed.
Tang, C., et al. (2012). Interleukin-23: As a drug target for autoimmune inflammatory diseases. Immunology.
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