Skyrizi
An injected biologic for moderate to severe plaque psoriasis. It blocks interleukin-23, a signal that sits high up in the psoriasis chain, and after two starting doses it is given about four times a year.
Key facts
Skyrizi at a glance.
Used for
Plaque psoriasis or psoriatic arthritis
Results
Assess at 16 weeks
Treatment commitment
Every 12 weeks after starter doses
Key precautions
TB screening and infection precautions
What is it?
Top things to know about Skyrizi
- It is an IL-23 inhibitor. Risankizumab blocks the p19 subunit of IL-23.
- It treats psoriasis and psoriatic arthritis. It is labeled from age six, with weight-based dosing.
- Response is not guaranteed. It does not remove infection or allergy risk.
- Bowel disease regimens differ. Crohn’s and colitis dosing should not be copied.
Often used for
What Skyrizi is used for
HOW IT WORKS
How Skyrizi works
Diagram explanation and sources
Blocks IL-23: Binds this immune messenger before it reaches its receptor. Turns down inflammatory T cells: Reduces signals that keep the psoriasis cycle active. Helps plaques clear: Excess skin buildup and inflammation gradually decrease.
Risankizumab selectively targets the p19 subunit of IL-23, not IL-12. The T-cell and skin changes are a simplified downstream interpretation.
Strengths
Risankizumab strengths
For adult plaque psoriasis, the labeled risankizumab dose is 150 mg under the skin at weeks 0 and 4, then every twelve weeks. Different-strength bowel-disease products and intravenous induction are not stronger psoriasis options.
150 mg
The dose is paired with a defined schedule. Other device strengths for Crohn’s disease or ulcerative colitis should not be substituted into that regimen.
Strength sources
Forms
Risankizumab forms
Prefilled pen
An injector supplied with medication inside. Grip, activation and needle handling depend on the device.
Prefilled syringe
A syringe supplied with liquid medication inside. A plunger controls the injection; needle handling depends on the device.
How to use it
Your treatment, step by step.
How to take it
- 01
When to take it
Any time of day. The calendar matters more here than with a weekly drug. Twelve weeks is long enough that people lose track, so put every dose date in your phone and book the next reminder the day you inject.
Take it out of the fridge 15 to 30 minutes before and let it warm on the counter. Cold liquid stings. No hot water, no microwave.
Inject into the front of the thigh or the belly, at least two inches from the navel. The back of the upper arm works if someone else is doing it. Rotate the site, avoid skin that is bruised, tender, hard or scarred, and never inject through a plaque. Ask for training before the first dose. Used devices go in a sharps container. - 02
If you miss a dose
Inject as soon as you remember, then count twelve weeks from that day. If it has been much longer than twelve weeks, call the prescriber first so the schedule can be reset.
Monitoring & follow-up
Everyone is screened for tuberculosis before the first dose — a skin test or TB blood test, plus a chest X-ray if that is positive. Dormant TB is treated first. This class probably carries less TB risk than the TNF blockers, but screening is not optional.
Hepatitis B and C are usually checked at the same time.
After that there is no fixed blood test schedule. Risankizumab does not need the regular liver and blood count testing methotrexate does. Monitoring is clinical: the skin, whether infections are more frequent, whether the dose dates are kept. TB testing is repeated yearly or by exposure risk.
There is no boxed warning. The most common side effects reported are upper respiratory infections, headache, tiredness, fungal skin infections and injection site reactions. Serious allergic reactions are rare but are why the first dose is often given with someone trained nearby.
What to expect
How things change over time.
The injection
A sharp sting for a few seconds, then redness or a small welt. Settles within a day or two.
Starting
Itch settles first. Scale lifts and plaques thin.
Working
Most of the change happens here, from the second dose on. Plaques flatten and redness fades from the middle out, often leaving a paler or darker mark.
Judge it here
Most people reached 90 percent clearer skin, and many were clear or nearly clear. Joints improve on the same timeline.
Scalp, palms and soles
Slower than the trunk and limbs.
Nails
Last to change, because a nail takes months to grow out.
Steady state
Most people notice no dip. If plaques reliably return in the last few weeks, say so.
- First few minutes
- Weeks 1 to 4
- Weeks 4 to 16
- Week 16
- 3 to 6 months
- 6 to 12 months
- Between doses
When you stop
No taper, no withdrawal reaction. Stopping does not set off the sudden severe flare that stopping oral steroids can.
The drug clears slowly, so psoriasis usually comes back slowly too, often several months after what would have been the next dose. A long quiet gap is not proof the psoriasis has gone.
Restarting after a break generally works. Antibodies against the drug are reported less often with this class than with the older biologics. If you need to stop for surgery, an infection or a pregnancy plan, plan it in advance so the restart can be timed.
What it Pairs with
Skyrizi + your routine
| Product or situation | With Skyrizi | What to know |
|---|---|---|
| Live vaccines | Avoid | These contain a weakened live germ — measles-mumps-rubella, chickenpox, yellow fever and the nasal spray flu vaccine. Have any you need before you start. Non-live vaccines, including the flu shot, COVID vaccines and Shingrix, are usually encouraged. |
| Injecting during a fever or infection | Avoid | Hold the dose and call the prescriber. On this schedule a dose can wait a week or two. |
| Injecting into a plaque or bruise | Avoid | Hard, red or tender skin counts too. It hurts more and absorbs less predictably. |
| Letting the device freeze or overheat | Avoid | Sitting in sunlight counts. Replace it rather than use it. |
| Letting the schedule drift by months | Avoid | The most common practical problem with this drug — the gap is long enough to forget. |
| Reusing a pen or syringe | Avoid | Every device is single use. |
| If you have ever had tuberculosis, a positive TB test, or close contact with someone who had TB | Use care | Dealt with before the first dose. |
| If you have hepatitis B or C, or have ever been told you are a carrier | Use care | Checked before starting. |
| If you have an infection now, or one that keeps coming back | Use care | Doses are held until it clears. |
| If you have Crohn's disease or ulcerative colitis | Use care | Risankizumab treats these too, at a different dose and route, so both doctors need to know. |
| If you are due any vaccine, especially a live one | Use care | Live vaccines are handled differently. |
| If you have surgery planned | Use care | The long interval usually makes timing easy, but plan it. |
| If you are pregnant or breastfeeding | Use care | Planning a pregnancy counts too. Ask the doctor managing your pregnancy before you start, continue or stop. |
| If you get swelling of the face or lips | Use care | Tongue swelling, hives or trouble breathing counts too. Emergency care, not a phone call. |
| If you develop a fever or lasting cough | Use care | Night sweats or unexplained weight loss count too. Get checked promptly. |
Side effects & when to get help
The IL-23 injections are the best tolerated of the psoriasis biologics. Most people report nothing beyond the occasional cold.
Common
Colds and upper airway infections
Injection site reaction: Redness or soreness for a day or two.
Headache
Tiredness after a dose
Tell your doctor
An infection that is not clearing
A painful rash in a band, or blisters: Shingles.
Rising liver enzymes: Uncommon, and checked if you have symptoms.
Any live vaccine you are offered: Ask your doctor first.
Stop and get care
Fever with shaking chills or feeling very ill
A cough with fever, night sweats and weight loss: Tuberculosis is screened for before you start.
Hives, facial swelling or trouble breathing
Getting it and cost
Getting Skyrizi.
Cost & access
The list price runs to tens of thousands of dollars a year. Almost nobody pays that; what you pay depends on your plan.
What affects the cost
It is brand only — no generic, no biosimilar — so there is no cheaper equivalent to switch to. That is a real difference from adalimumab.
What affects the cost
Prior authorization is close to universal. Most plans require documented failure of something cheaper first — phototherapy, methotrexate, sometimes another biologic. Denials are usually about missing records rather than the drug, and appeals succeed reasonably often when the history is documented.
What affects the cost
Manufacturer copay cards can cut the cost to very little with commercial insurance. By law they cannot be used with Medicare or Medicaid. For those plans, or no insurance, the manufacturer's patient assistance program and independent foundations are the usual routes. Terms change often.
One practical note
because doses are twelve weeks apart, a change of insurance or a formulary switch in January can land in the middle of a dosing gap. Check coverage before the next dose is due, not the week it is.
Alternatives
Other options to consider.
Methotrexate
And decades of use. A cheap weekly tablet or injection, but it clears skin fully for fewer people, needs regular blood tests, and cannot be used in pregnancy.
Phototherapy
With no drug in the body. The trade-off is time: two or three clinic visits a week for months.
TNF blockers
Such as adalimumab and etanercept. Strong evidence, a much longer safety record, and biosimilars that lower the cost. They are injected far more often, and carry a boxed warning about serious infections and cancers that this class does not.
IL-17 blockers
Such as secukinumab, ixekizumab and bimekizumab. Strong evidence and fast onset. Different side effect pattern, including yeast infections, and they can worsen inflammatory bowel disease.
Other IL-23 blockers
Such as guselkumab and tildrakizumab. Same target and similar schedules. The choice between them is usually driven by coverage and by which conditions each is approved for.
Ustekinumab
An older drug in the same family that blocks interleukin-12 as well as 23. It has biosimilars now, which can make it much cheaper.
Oral options
Such as deucravacitinib and apremilast. No needles and no fridge, and generally less complete skin clearing than a biologic. Some people take that trade willingly.
Questions
Questions you might be asking.
What does biologic mean?
A large protein grown in living cells rather than a chemical made in a factory. That is why it is injected, and why it lives in the fridge.
Really only four injections a year?
After the first two doses, four weeks apart, yes. The drug stays in the body long enough that the gap can be twelve weeks.
Does the injection hurt?
A few seconds of stinging. Letting it warm to room temperature first makes a noticeable difference.
Do I need blood tests while I am on it?
Tuberculosis and hepatitis before you start, and TB testing often repeated yearly. Beyond that, no routine schedule.
What happens if I am late with a dose?
Inject when you remember and count twelve weeks from that day. If you are weeks or months late, call first.
Can I have vaccines?
Yes, apart from live ones. The flu shot, COVID vaccines and Shingrix are not live. Have any live ones before starting.
Related
Keep exploring.
Psoriasis
Scalp Psoriasis
Methotrexate
Eczema
Phototherapy
Hidradenitis Suppurativa
Methotrexate vs Skyrizi
Calcipotriene vs Skyrizi
Clobetasol vs Skyrizi
Cyclosporine vs Skyrizi
Humira vs Skyrizi
