Humira vs Skyrizi

Adults are not dosed by body weight. You start with a larger loading dose to get levels up fast, then settle into an every-other-week rhythm.

Starting dose: 80 mg on day one, as one 80 mg injection or two 40 mg injections at different spots.

One week later: 40 mg.

Usual dose: 40 mg every other week, the same day of the week each time.

If it stops working: Some people move to weekly injections, others switch drugs. The prescriber's call.

Other conditions: Hidradenitis suppurativa uses a heavier loading dose and weekly maintenance, so do not assume a friend's schedule matches yours.

How long: Long term, with no set course length. It continues while it works and is tolerated.

Any time of day, but pick a set day of the week and keep to it. Every other week is easy to lose track of, so set a phone reminder on day one.

Take the pen or syringe out of the fridge 15 to 30 minutes before injecting. Cold liquid stings more. Do not warm it in the microwave or hot water.

Inject into the front of the thigh or the belly, at least two inches from the navel. Rotate the spot each time, and avoid skin that is bruised, red, hard, tender or scarred. Never inject through a plaque. A nurse or pharmacist should train you in person for the first dose. Used pens go in a sharps container, never the household bin.

Inject as soon as you remember, then return to your original schedule rather than shifting future doses. Never inject two doses to catch up. If you have missed more than one dose, call the prescriber before restarting — long gaps can blunt how well it works.

Everyone is screened for tuberculosis before the first dose — a skin test or TB blood test, often with a chest X-ray. TNF blockers can wake a dormant TB infection, so a positive screen is treated first and adalimumab waits until that treatment is under way. Testing is often repeated yearly, or sooner if you live somewhere TB is common.

Hepatitis B and C are checked too, because hepatitis B can reactivate when the immune signal is blocked.

After that there is no fixed blood test schedule like methotrexate's. Many doctors check a blood count and liver tests occasionally. Most monitoring is clinical — how the skin looks, and whether you are getting more infections than usual.

Skin should be checked periodically, because TNF blockers are linked to a small increase in skin cancer. The label also carries a boxed warning about serious infections and about lymphoma and other cancers, based mostly on rare cases in children and young adults. The absolute risk is low, but it is why this prescription gets regular review.

First few minutesThe injection: A sting for a few seconds. Injection site reactions, if they happen, show up in the first weeks.

Weeks 1 to 4Starting: Itching often eases before the plaques look different, and some people see the scale thin early.

Weeks 4 to 12Working: Plaques flatten, scale lifts and redness fades from the middle outward. Most of the visible change happens here. Psoriatic arthritis improves on a similar timeline, and hidradenitis suppurativa settles to fewer painful lumps on its own heavier schedule.

Week 16Judge it here: The point the trials measured. Most people reached at least a 75 percent improvement in skin involvement and severity, and a smaller share cleared almost completely.

Months 6 to 12Nails: The slowest, because a nail takes months to grow out. Pitting and lifting improve well after the skin has settled.

After the first yearLong term: Most people who respond keep responding.

The list price is very high, tens of thousands of dollars a year. Almost nobody pays that. What you pay depends on your insurance, and getting there takes paperwork.

Prior authorization is close to universal. Most plans require you to have tried and failed something cheaper first — phototherapy, methotrexate or another systemic drug — and they want records to prove it.

Biosimilars changed the picture. Several have been sold in the United States since 2023, some at much lower list prices. Which one you get is usually decided by your plan's formulary, not your dermatologist, and plans switch year to year. A switch is a paperwork event, not a medical downgrade, though you may need retraining on a different pen.

Manufacturer copay cards can bring the cost down to very little with commercial insurance. By law they cannot be used with Medicare or Medicaid. For those plans, or with no insurance, manufacturer and foundation assistance programs are the usual route, and their rules change often.