How Skyrizi Works for Psoriatic Arthritis

Medically Reviewed by Beth Johnston, PharmD, BCPS on August 23, 2024
7 min read

People with psoriatic arthritis (PsA) often take medicines to help manage their condition and improve their symptoms. Some of these medicines work directly on the body’s immune system and help to limit the swelling (inflammation) that causes damage to the joints over time. 

Although some people will be able to manage PsA with oral medicines, others may need to use medicines that are injected into the body. One of these medicines, called Skyrizi, may help to improve symptoms in people who do not get enough benefit from oral medicines and certain types of injected medicines. 

Psoriasis is a type of autoimmune condition, which means that the body’s immune cells attack its own healthy cells. Although most people with psoriasis have skin symptoms (plaque psoriasis), some people with psoriasis will also develop joint symptoms. This type of psoriasis is called psoriatic arthritis (PsA) and involves swelling in the joints. People with this condition often have warm, swollen, tender, and painful joints. Over time, the swelling can cause permanent damage, which can make the joints very painful and difficult to use.

The joints most often affected by PsA are the fingers, wrists, ankles, and knees, although other joints, such as the neck and hips, can also be affected. While some people may only have these issues in one or two joints, others may have pain and swelling in multiple joints. Some people may also feel extremely tired or have a low fever.

Each person with PsA may have a different experience. Some people with this condition will have periods of “remission,” when the pain or stiffness goes away for some length of time. Others will have “flare-ups,” where symptoms become much worse. These flare-ups can last for days or months and may be due to stress or changes in treatment. If a person is having symptoms of PsA, their disease is considered “active.” 

The key to treating PsA is to reduce the swelling in the joints. This can help reduce pain and stiffness and also help prevent permanent damage to the joints. It is important to start treatment as soon as possible after receiving a diagnosis, so that the damage to the joints does not become severe.

There are many medicines available that help stop the immune system from attacking its own cells and causing swelling. Since these medicines prevent damage to the joints over time, they are called disease-modifying antirheumatic drugs (DMARDs). Some of these medicines are taken by mouth and others are injected into the body. People with PsA may take more than one DMARD, as well as other medicines, to help manage the pain and swelling in their joints.

Skyrizi is a DMARD that is injected into the body. The main ingredient in Skyrizi is a medicine called risankizumab. This medicine blocks a substance called interleukin-23 (IL-23) from working. People with PsA have too much IL-23, which increases swelling. By blocking IL-23, Skyrizi can decrease the swelling in the joints, preventing damage and reducing pain and stiffness.

Two studies were done to see if Skyrizi was safe and effective for the treatment of PsA. All of the people in these studies had active PsA and had been diagnosed 7-8 years before the study started, on average. About half of the people in the study were female and about half were male. The average age of the people in the studies was 52. Most (95%) were White, about 3% were Asian, and less than 1% were Black, Native Hawaiian or Pacific Islander, or American Indian or Alaska Native. 

Everyone in these studies had already tried at least one DMARD in the past:

  • In one study, everyone had tried at least one oral DMARD and about one-third had tried at least two oral DMARDs. 
  • In the other study, everyone had tried at least one oral or injectable DMARD. About half of these people had tried an injectable DMARD. 

Skyrizi was compared with a placebo, and no one knew if they were receiving the medicine or the placebo. If anyone was using an injectable DMARD before the study started, this medicine was stopped. If anyone was using an oral DMARD before the study started, they were told to continue taking it during the study.

These studies measured efficacy by looking at how much a person’s symptoms improved. This was done by counting how many tender and swollen joints a person had before and during the study. Patients and health care professionals were also asked to rate symptoms on a scale throughout the study. If a person’s symptoms improve by at least 20%, this is considered a meaningful change.

Improvement in symptoms. After 6 months into the study, the people who used Skyrizi were more likely to have their PsA symptoms improve by at least 20%. A little more than half (51%-57%) of people who used Skyrizi had their symptoms improve by this much, compared with about one-quarter to one-third (26%-33%) of people who used a placebo. 

Some people in the studies had their PsA symptoms improve by a larger amount (at least 50%). About one-quarter to one-third (26%-33%) of people who used Skyrizi had their symptoms improve by this much, compared with about 10%-11% of people who used a placebo.

Skyrizi is a liquid that is injected under the skin. When you first start using this medicine, you will have a shot every 4 weeks for the first two doses. After that, you will have a shot every 12 weeks. Skyrizi can be injected into the thigh, stomach, or outer area of the upper arm. 

Skyrizi comes in two forms. The most common form is a pre-filled device that is ready to inject the drug under the skin, so you do not need to learn how to use a syringe and needle. The medicine also comes in a pre-filled syringe with a needle. In either case, your health care provider will show you how to inject the medicine before you use it the first time. The medicine is stored in the refrigerator. To make the shot more pleasant, it is helpful to let the medicine warm up to room temperature before using it.

It is important to inject the medicine properly so that you get the right dose. Your prescription should come with “Instructions for Use,” which explains how to prepare and give a dose. Ask your pharmacist or other health care provider if you are unsure how to use Skyrizi. 

If Skyrizi is working, your symptoms will start to improve over the first 1-2 months. Most people see the greatest improvements during the second and third months of using the medicine. Some people may continue to see some improvement during the fourth month as well. 

Do not stop using this or any other medicines for PsA without talking to your health care provider first, even if your symptoms have gotten better. Your symptoms may get worse again if you stop or change any of your medicines. 

Tell your health care provider if your symptoms do not seem to be improving after about 2-3 months of using Skyrizi. Your health care provider may discuss other options for treating this condition. 

Skyrizi can cause a skin reaction where you get the shot, which may involve redness, pain, itching, and swelling. To help reduce the risk of this happening, don’t inject the medicine into a psoriasis plaque or any skin that is already tender, damaged, bruised, or scarred.

People who use Skyrizi are more likely to have infections, especially an infection of the airways. These include infections in the nose or throat, a sore throat, or common cold symptoms. The best way to prevent infection is to reduce your exposure to germs by washing your hands and avoiding people who are sick. You should also stay current on vaccinations, such as getting an annual flu vaccine. Before you start Skyrizi, speak with your health care professional about whether you are due for any vaccines.

These are not all of the possible side effects. Talk with your health care provider if you are having symptoms that bother you. If you experience anything that you think may be caused by Skyrizi, you can also report side effects to the FDA at 800-FDA-1088 (800-332-1088).

There are no known interactions between Skyrizi and other medicines. But it is still important for your health care provider to be aware of all the prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, or other supplements you take or have recently taken. 

It is important to discuss any recent or upcoming vaccines (immunizations) with your health care provider. There are certain vaccines (“live” vaccines) that you should not receive either right before starting Skyrizi or once you have already started using it. Your health care provider will confirm whether any recent or upcoming vaccines are safe.

Skyrizi is a “specialty” medicine. This means that you can only get it from a specialty pharmacy and that it may require prior authorization from your insurance company. 

There is a savings coupon available from the drugmaker that may allow you to pay as little as $0 for your prescription. Whether you are eligible depends on whether you have prescription insurance, and what type of insurance you have. You can find out more at https://www.skyrizi.com/psoriasis-psoriatic-arthritis/cost-and-savings.