Skyrizi vs Stelara for Crohn's Disease - Effectiveness, Dosing, Side Effects

Skyrizi vs Stelara for Crohn's Disease Treatment

Crohn's disease is an inflammatory bowel disease that causes chronic inflammation and damage to the digestive tract. There is no known cure for Crohn's, but treatments aim to reduce active disease and achieve remission.

Two newer drugs used to treat moderate to severe Crohn's disease are Skyrizi and Stelara. But what's the difference between these two biologic medications? Let's compare Skyrizi vs Stelara for Crohn's to see the pros and cons of each treatment option.

What Are Skyrizi and Stelara?

Both Skyrizi and Stelara are biologic drugs that work by blocking specific proteins in the immune system to reduce inflammation. This helps calm an overactive immune response.

Skyrizi

Skyrizi contains the active drug risankizumab-rzaa. It was approved by the FDA in 2019 for treating moderate to severe plaque psoriasis. In 2021, it was also approved for Crohn’s disease.

Skyrizi is an interleukin-23 (IL-23) inhibitor. It works by blocking the IL-23 protein which helps activate inflammatory responses.

Stelara

Stelara contains the active drug ustekinumab. It was first approved in 2009 to treat plaque psoriasis. In 2016, the FDA also approved Stelara injections for treating Crohn’s disease.

Stelara targets two proteins involved in inflammation: interleukin-12 (IL-12) and interleukin-23 (IL-23). By inhibiting these proteins, it reduces inflammatory reactions.

Effectiveness for Crohn's Disease

Studies have found both Skyrizi and Stelara to be effective at reducing Crohn's disease symptoms and helping patients achieve remission.

Skyrizi

In clinical trials, significantly more patients taking Skyrizi achieved clinical remission of Crohn's symptoms compared to placebo after one year of treatment.

Nearly 25% of Skyrizi patients reached remission after just 12 weeks. After a year, 57% of Skyrizi users were in remission, compared to only 19% for placebo.

Stelara

The first Stelara study for Crohn's disease found clinical remission rates of 39% after 8 weeks and 45% after one year, compared to 23% and 28% for placebo.

A more recent trial showed remission rates of 55% for Stelara and 44% for placebo after one year. Stelara was also better at reducing Crohn's disease symptoms.

Based on these studies, both biologics appear effective, but Skyrizi may have a slight edge at achieving remission after 1 year of treatment.

Onset of Action

An advantage of Skyrizi is that it starts working more quickly than Stelara:

• Skyrizi - Within 4 weeks
• Stelara - May take up to 16 weeks

Skyrizi produces a rapid reduction in inflammatory markers. Symptom improvements can happen within days after the first dose.

Stelara often takes 12-16 weeks to reach full effect. The delay is because it modulates immune pathways indirectly, which takes longer.

For quicker relief, Skyrizi may be preferable. But Stelara can still be very effective long-term.

Dosage and Administration

Both Skyrizi and Stelara are given as injections under the skin (subcutaneously). However, the dosing schedule differs:

• Skyrizi - Two starter doses 4 weeks apart, then every 12 weeks
• Stelara - Single starting dose, then maintenance dose every 8 weeks

Skyrizi's dosing requires more frequent injections initially. But maintenance is a bit less often than Stelara (12 vs 8 weeks between doses).

Skyrizi comes in a prefilled syringe or pen that patients can self-inject at home. The needle is very thin to maximize comfort.

Stelara is given by a doctor or nurse during the starter dose. After training, patients can self-administer maintenance doses.

Side Effects

Both medications can cause side effects, but they are generally mild. Common side effects may include:

• Injection site reactions
• Headaches
• Joint pain
• Nausea
• Fatigue

Skyrizi has slightly lower risks of overall side effects compared to Stelara based on clinical trials.

Rare serious side effects are possible with immunosuppressants like infection, skin cancer, and allergic reaction. Patients should be monitored closely by their doctor.

Cost and Insurance Coverage

Skyrizi and Stelara are both branded biologic drugs, which makes them expensive. However, most insurance plans cover a large portion of the costs.

Skyrizi has an average retail cost of over $22,000 per year. With insurance and savings programs, the out-of-pocket cost may range from $5 to $20 per dose.

Stelara costs around $18,000 annually. After insurance, patients pay anywhere from $5 to $200 per dose.

Speech and financial assistance are available for both drugs. Working with your insurance provider can help minimize out-of-pocket expenses.

Key Differences

To summarize, here are some of the main differences between Skyrizi and Stelara:

• Mechanism - Skyrizi blocks IL-23; Stelara blocks IL-12 and IL-23
• Onset of action - Skyrizi works within 4 weeks; Stelara within 12-16 weeks
• Dosing schedule - Skyrizi every 12 weeks after loading doses; Stelara every 8 weeks
• Side effects - Skyrizi has slightly lower overall side effects
• Cost - Skyrizi is slightly more expensive than Stelara

Which Is Better for Crohn's: Skyrizi or Stelara?

There is no definitive "winner" between Skyrizi and Stelara for Crohn's disease. Both are highly effective biologic medications.

Skyrizi may work more quickly to induce remission and requires less frequent maintenance dosing. But Stelara has a longer track record of safety and efficacy.

Key factors in choosing between them include:

• Speed of onset needed
• Dosing and administration preferences
• Side effect risks and tolerability
• Insurance coverage and out-of-pocket costs

Work with your doctor to weigh the pros and cons of each. Choosing between Skyrizi and Stelara depends on your specific health needs and treatment goals.

If one biologic does not provide adequate symptom relief and remission, your doctor may suggest trying the other option to see if it is more effective.

Used together with other Crohn's medications and lifestyle approaches, Skyrizi or Stelara can help manage moderate to severe Crohn's disease long-term.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.