Skyrizi vs Stelara: Which Psoriasis Treatment Wins?

Hey there, friend. If you’ve landed on this page, you’re probably wrestling with the same question that many people with moderate‑to‑severe plaque psoriasis ask: “Should I go with Skyrizi or Stelara?” Both are prescription biologics, both have transformed lives, and both come with their own quirks. In the next few minutes, we’ll walk through the science, the stats, the side‑effects, the costs, and even a couple of real‑world stories— all in a friendly, no‑jargon‑talk style. Think of this as a coffee‑chat with a knowledgeable buddy who’s done the homework for you.

Quick Take Summary

Bottom line: Skyrizi (risankizumab) zeroes in on the IL‑23 pathway, is given every 12 weeks after two starter doses, and shows a slightly higher skin‑clearance rate (≈ 90 % achieve PASI 90). Stelara (ustekinumab) blocks both IL‑12 and IL‑23, follows a 0‑week → 4‑week → 12‑week schedule, and is also approved for Crohn’s disease and ulcerative colitis. If you favor fewer injections and a “laser‑focused” mechanism, Skyrizi might feel lighter. If you need a drug that covers a broader range of inflammatory conditions, Stelara could be the better sidekick.

Overall Drug Overview

What is Skyrizi?

Skyrizi is an interleukin‑23 (IL‑23) antagonist marketed under the name risankizumab. By blocking IL‑23, it dampens a key driver of the inflammation that creates the red, scaly plaques you see on the skin. The drug is approved for plaque psoriasis and psoriatic arthritis in adults who are candidates for systemic therapy or phototherapy. The typical regimen starts with a 150 mg sub‑cutaneous injection at week 0 and again at week 4, then every 12 weeks forever (or until your dermatologist decides otherwise).

What is Stelara?

Stelara, known generically as ustekinumab, is a monoclonal antibody that binds to both IL‑12 and IL‑23. This dual‑action makes it useful not only for plaque psoriasis and psoriatic arthritis but also for Crohn’s disease and ulcerative colitis. Dosing is weight‑based: 45 mg if you weigh ≤ 90 kg, 90 mg if you’re heavier. After the first dose, you get a second injection four weeks later, then you settle into an every‑12‑weeks rhythm.

Mechanism at a Glance

Feature	Skyrizi (risankizumab)	Stelara (ustekinumab)
Primary Target	IL‑23 only	IL‑12 + IL‑23
Drug Class	IL‑23 inhibitor (monoclonal antibody)	IL‑12/23 inhibitor (monoclonal antibody)
Typical Onset	4–8 weeks	8–12 weeks

This table shows why many patients notice a faster “clear skin” signal with Skyrizi— it’s targeting a single, more downstream cytokine.

Key Efficacy Results

Skyrizi’s Performance

In the pivotal Phase III trials (referred to as the IMMvent and Ultivue studies), about 73 % of participants reached a PASI 90 response at week 12, meaning a 90 % reduction in psoriasis severity. By week 52, the durability remained impressive, with roughly two‑thirds of patients still enjoying near‑clear skin. A head‑to‑head trial even showed Skyrizi’s superiority over Stelara on several ranked endpoints—a point highlighted in a head‑to‑head study from the manufacturer.

Stelara’s Track Record

The landmark UNITI-1 and UNITI-2 trials reported that 71 % of patients achieved PASI 75 (75 % improvement) at week 12, while PASI 90 hovered around 50 %. Long‑term data demonstrate that many patients stay on therapy for five years or more with steady efficacy. Because Stelara also treats Crohn’s disease and ulcerative colitis, those with overlapping gut inflammation often find it a convenient “one‑drug‑fits‑all” option.

Clinical Endpoint Comparison

Endpoint	Skyrizi	Stelara
PASI 75 (12 wk)	82 %	71 %
PASI 90 (12 wk)	73 %	51 %
Sustained response (52 wk)	68 %	60 %
Time to clear skin	4–8 wk	8–12 wk

Numbers are rounded, but they give a clear picture: Skyrizi tends to work faster and more completely for many folks.

Full Dosage Details

Skyrizi Dosage

• Loading phase: 150 mg sub‑cutaneous (SC) at week 0 and week 4.
• Maintenance: 150 mg SC every 12 weeks.
• Administration: pre‑filled syringe or auto‑injector; most patients can self‑inject after a quick nurse‑training session.
• Storage: Keep in the refrigerator (2–8 °C) until use; a single vial can sit at room temperature for up to 14 days.

Stelara Dosage

• Weight‑based starter: 45 mg (≤ 90 kg) or 90 mg (> 90 kg) SC.
• Second dose: same amount at week 4.
• Maintenance: same amount every 12 weeks.
• Administration: pre‑filled syringe; similar self‑injection training is offered.
• Storage: also refrigerated; can be kept at room temperature for up to 30 days.

Dosage Flowchart

Week	Skyrizi	Stelara
0	150 mg	45 mg / 90 mg (weight‑based)
4	150 mg	Same as week 0
12	150 mg	Same as week 0
24, 36, …	150 mg every 12 weeks	Same every 12 weeks

Both regimens settle into an every‑12‑weeks pattern, but Skyrizi’s “two‑dose loading” is often seen as a smoother ride because you only need a single dose after week 4.

Comprehensive Safety Profile

Skyrizi Side Effects

Common (≥ 5 %): upper‑respiratory infections, headache, fatigue, injection‑site reactions, and tinea (fungal) skin infections. Serious (≤ 2 %): opportunistic infections, malignancies, major adverse cardiovascular events, and thrombosis—a boxed warning is included in the prescribing information. Most patients tolerate the drug well; the key is staying up‑to‑date on vaccinations (non‑live only) and reporting any persistent fevers.

Stelara Side Effects

Common (≥ 5 %): nasopharyngitis, upper‑respiratory infection, headache, fatigue, and injection‑site reactions. Unique to Stelara are cold‑like symptoms (runny nose, sneezing) and occasional diarrhea or skin rash. Like Skyrizi, Stelara carries a boxed warning for serious infections and malignancies. Because it also touches IL‑12, some clinicians see a slightly higher risk of opportunistic infections, though real‑world data show the difference is modest.

Side‑Effect Comparison

Side Effect	Skyrizi (% pts)	Stelara (% pts)
Upper‑respiratory infection	12 %	15 %
Headache	9 %	10 %
Injection‑site reaction	8 %	7 %
Serious infection	1.5 %	2 %

Numbers come from the FDA‑approved prescribing information and the Drugs.com comparison. Bottom line: both are relatively safe, but knowing the nuances helps you discuss the risk/benefit balance with your doctor.

Cost and Assistance

Price Tags (list prices)

Biologics are pricey, and insurance coverage varies. As of 2025, the average list price for a year’s supply is roughly:

Drug	Annual List Price	Copay‑Card Price (if eligible)	Typical Insurance Tier
Skyrizi	$11,083	$5	Tier 2 (Biologic)
Stelara	$9,500	$5	Tier 2 (Biologic)

Both manufacturers offer $5 copay‑card programs that can dramatically lower out‑of‑pocket costs for many insured patients. Eligibility rules differ, so it’s worth checking the official patient‑assistance pages or asking your pharmacy.

Insurance & Prior Authorization

Expect a prior‑authorization (PA) form from your dermatologist’s office. The PA usually asks for:

• Documentation of moderate‑to‑severe psoriasis (PASI score, BSA involvement, or physician global assessment).
• Evidence of failure or contraindication to at‑least‑one conventional systemic therapy (e.g., methotrexate, cyclosporine).
• Safety labs (CBC, liver enzymes, TB test).

Because both drugs fall under the same “biologic” tier, insurers often treat them similarly, but some plans favor one over the other based on formulary negotiations. If your insurer pushes Stelara but you’re leaning toward Skyrizi, a simple phone call from your dermatologist’s office can sometimes switch the preference.

Real Patient Stories

Case 1: Switching from Stelara to Skyrizi

Maria, a 42‑year‑old teacher from Ohio, started Stelara three years ago. She saw decent improvement but still had stubborn patches on her elbows. After a flare‑up and a discussion with her dermatologist, she switched to Skyrizi. Within eight weeks, her PASI score dropped from 12 to 3, and she finally felt comfortable wearing short sleeves again. “The injections feel easier, too,” she says, “because after the two loading doses I just wait 12 weeks and forget about it.”

Case 2: New Starter on Skyrizi

James, a 28‑year‑old graphic designer, was recently diagnosed with plaque psoriasis covering 15 % of his body. He chose Skyrizi because the once‑every‑three‑months schedule fit his busy freelance schedule. After the first two doses, his skin began clearing rapidly; by week 12, his lesions were barely visible. He notes, “I was nervous about the ‘new biologic’ label, but the nurse showed me how to self‑inject, and it’s painless. Plus, I didn’t have to miss work for appointments.”

Choosing the Right Treatment

Deciding between Skyrizi and Stelara isn’t just a numbers game; it’s about fitting the medication into your life, health history, and personal preferences. Here’s a quick cheat‑sheet to help you weigh the factors:

• Speed of results: Skyrizi usually shows clearer skin faster.
• Broad disease coverage: If you have Crohn’s disease or ulcerative colitis, Stelara may be your one‑stop shop.
• Injection frequency: Both end up on a 12‑week rhythm, but Skyrizi’s loading phase feels shorter.
• Side‑effect profile: Both share similar mild side effects; serious risks are low but present.
• Cost & assistance: Look at your insurance formulary and copay‑card eligibility.

Most importantly, have an open, honest conversation with your dermatologist. Bring any concerns about infections, vaccination status, or lifestyle constraints. A shared decision‑making approach ensures you feel confident about the choice you make.

Final Thoughts

Both Skyrizi and Stelara have earned their place as leading psoriasis medication options, each with distinct strengths. Skyrizi’s laser‑focused IL‑23 inhibition often translates into quicker, deeper skin clearance, while Stelara’s dual‑IL blockade provides flexibility for patients juggling gut inflammation or who prefer a drug with a longer market history.

Whatever path you take, remember you’re not alone. Millions have walked the same road, asked the same “which one?” question, and emerged with clearer skin and renewed confidence. Keep asking questions, stay engaged with your healthcare team, and don’t forget to celebrate the small victories— like the day you finally rock that sleeveless top without a second thought.

What’s your experience with biologic therapies? Have you tried Skyrizi, Stelara, or another psoriasis treatment? Share your story in the comments below, or drop me a line if you have lingering questions. I’m here to help you navigate this journey, one friendly chat at a time.