What Are Skyrizi and Tremfya?

Skyrizi (risankizumab) and Tremfya (guselkumab) are both FDA-approved biologic medications used primarily to treat moderate to severe plaque psoriasis. These medications belong to a class of drugs called interleukin inhibitors, which work by targeting specific parts of the immune system responsible for the inflammation that causes psoriasis symptoms.

Skyrizi, manufactured by AbbVie, specifically blocks interleukin-23 (IL-23), a protein that triggers inflammatory responses in the body. It was approved by the FDA in 2019 and has since gained approval for treating psoriatic arthritis as well. Tremfya, produced by Janssen Pharmaceuticals, also targets IL-23 but with a different mechanism of action. It received FDA approval in 2017, making it the first IL-23 inhibitor available for psoriasis treatment.

How These Medications Work

Both Skyrizi and Tremfya function as selective interleukin-23 inhibitors, but they target different parts of the IL-23 protein. This subtle difference can affect how patients respond to each medication.

Skyrizi binds to the p19 subunit of IL-23, preventing it from interacting with its receptor. By blocking this interaction, Skyrizi reduces the release of pro-inflammatory cytokines and chemokines that contribute to psoriasis symptoms. Tremfya also targets the p19 subunit of IL-23 but uses a different antibody structure. These medications disrupt the inflammatory cascade that leads to the rapid skin cell growth and inflammation characteristic of psoriasis, ultimately resulting in clearer skin.

Both treatments are administered via injection, but with different schedules. Skyrizi is typically given as two injections initially, followed by two injections at week 4, and then every 12 weeks thereafter. Tremfya starts with an injection at week 0, another at week 4, and then continues every 8 weeks. This difference in dosing schedules may be an important consideration for patients when choosing between these treatments.

Treatment Efficacy Comparison

When comparing Skyrizi and Tremfya, clinical trial results provide valuable insights into their effectiveness. Both medications have demonstrated impressive efficacy in treating plaque psoriasis, but there are some differences worth noting.

In clinical trials, approximately 75% of patients taking Skyrizi achieved PASI 90 (a 90% improvement in psoriasis symptoms) after 16 weeks of treatment. For Tremfya, about 70% of patients reached PASI 90 at the same timepoint. Both medications show continued improvement with longer treatment duration.

A key difference appears in the speed and durability of response. Some studies suggest that Skyrizi may provide faster initial clearing of skin symptoms, while Tremfya might offer slightly better long-term maintenance for some patients. However, individual responses vary significantly, and what works best depends on each patient's unique biology and condition severity.

It's also worth noting that both medications have shown efficacy in treating difficult areas like scalp psoriasis, nail psoriasis, and genital psoriasis, though the degree of improvement may differ between the two treatments.

Side Effects and Safety Profiles

The safety profiles of Skyrizi and Tremfya are generally similar, with both medications being well-tolerated by most patients. However, understanding the potential side effects can help patients make informed decisions.

Common side effects for AbbVie's Skyrizi include upper respiratory infections, headache, fatigue, injection site reactions, and fungal skin infections. For Janssen's Tremfya, common side effects include upper respiratory infections, headache, injection site reactions, joint pain, diarrhea, gastroenteritis, and herpes simplex infections.

Both medications may increase the risk of infections since they affect the immune system. Patients are typically screened for tuberculosis and other infections before starting either treatment. Neither drug should be used by patients with active infections, and vaccinations should be up-to-date before beginning treatment.

Regarding long-term safety, both medications have accumulated several years of post-marketing data. Current evidence suggests that both maintain favorable safety profiles with extended use, though continued monitoring is important.

Cost and Insurance Considerations

The cost of biologic treatments like Skyrizi and Tremfya is significant, with both medications having similar list prices of approximately $15,000-$20,000 per dose without insurance coverage. However, actual costs to patients vary widely based on insurance coverage, patient assistance programs, and other factors.

Most insurance plans, including Medicare and many private insurers, provide coverage for both medications, though they may prefer one over the other. This preference can significantly impact out-of-pocket costs. Both AbbVie and Janssen CarePath offer patient assistance programs that can reduce costs substantially for eligible patients.

The difference in dosing schedules may also affect annual costs. Skyrizi is administered less frequently (every 12 weeks after initial loading doses) compared to Tremfya (every 8 weeks after initial loading doses). This means Skyrizi requires fewer doses per year, potentially resulting in lower annual costs depending on insurance coverage.

When considering these treatments, patients should check with their insurance provider about coverage details and investigate manufacturer assistance programs. Healthcare providers can often help navigate these financial considerations and may be able to advocate for coverage of a specific medication if it's deemed medically necessary.

Conclusion

Choosing between Skyrizi and Tremfya ultimately depends on individual factors including symptom severity, comorbidities, lifestyle preferences, and insurance coverage. Both medications have proven highly effective for treating moderate to severe plaque psoriasis, with similar safety profiles and mechanisms of action. The main differences lie in their dosing schedules, with Skyrizi requiring fewer injections annually, and potentially in their speed and durability of response for individual patients. Consultation with a dermatologist who specializes in psoriasis treatment is essential to determine which option might work best for your specific situation. As with any medication, the benefits must be weighed against potential risks, and regular follow-up appointments are important to monitor treatment effectiveness and adjust as needed.

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This content was written by AI and reviewed by a human for quality and compliance.