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Skyrizi vs Otezla

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Overview

Skyrizi

Otezla

Comparative Analysis

Introduction

For patients with moderate to severe plaque psoriasis, certain medications that alter the immune response of the body can help in managing symptoms and slowing disease progression. Skyrizi and Otezla are two such drugs that are prescribed for psoriasis. They each impact different pathways in the immune system, but both have effects in mitigating inflammation associated with psoriasis. Skyrizi is an interleukin-23 (IL-23) inhibitor, primarily impacting IL-23 levels which play a crucial role in driving inflammatory responses. Otezla on the other hand is classified as a phosphodiesterase 4 (PDE4) inhibitor affecting cyclic adenosine monophosphate (cAMP) levels thus modulating inflammatory mediators.

Skyrizi vs Otezla Side By Side

AttributeSkyriziOtezla
Brand NameSkyriziOtezla
ContraindicationsCannot be taken if receiving live vaccinations or have a severe infection. Increases chances of infections such as tuberculosis (TB), viral infections like chickenpox and herpes, fungal or bacterial infections.Not recommended if you have had suicidal thoughts or actions; known to increase these tendencies in patients dealing with depression.
Cost$22,000 for two injections (150mg each) every 12 weeks$3,500 for a month’s supply (60 tablets) of 30 mg
Generic NameRisankizumabApremilast
Most Serious Side EffectSerious infections, severe allergic reactions, changes in visionDepression or suicidal thoughts, severe diarrhoea, nausea or vomiting
Severe Drug InteractionsMay require a period of about 5 weeks to clear from the system to prevent dangerous interactions with certain drugs.No specific severe drug interactions mentioned, but always consult healthcare provider for potential interactions.
Typical DoseSubcutaneous injection of 150 mg at the start, followed by additional doses at weeks 4 and 16, then every twelve weeks thereafterInitiated at a lower dosage of 10 mg on day one, gradually increased over the first five days up to a maintenance dose of 30 mg twice daily

What is Skyrizi?

Risankizumab (the generic name for Skyrizi) is a new-generation medication from the class of interleukin inhibitors, representing a significant advancement from the previous generation of drugs known as phosphodiesterase 4 inhibitors, like apremilast (Otezla). Risankizumab was first approved by the FDA in 2019. It works by selectively blocking the IL-23 protein that plays a key role in chronic immune-mediated diseases, effectively reducing inflammation and skin cell production. This makes it an effective treatment option for moderate to severe plaque psoriasis. Unlike apremilast which affects multiple immune pathways resulting in more potential side effects such as diarrhea and weight loss, risankizumab has a more targeted action with fewer reported side effects due to its specific influence on IL-23 alone.

What conditions is Skyrizi approved to treat?

Skyrizi is authorized by the FDA for different types of conditions:

  • Moderate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy
  • Psoriatic arthritis (in combination with another drug, methotrexate)

Otezla carries approval for these conditions:

  • Moderate to severe plaque psoriasis in patients who are candidates for phototherapy or systemic therapy
  • Active psoriatic arthritis
  • Oral ulcers associated with Behçet’s Disease.

How does Skyrizi help with these illnesses?

Skyrizi assists in managing symptoms of psoriasis by neutralizing interleukin-23, a protein involved in inflammatory processes within the body. It does this by binding to this protein and preventing it from interacting with its receptor, thereby blocking its effects. Interleukin-23 is one of the key players in promoting inflammation and keratinocyte proliferation—two fundamental aspects of psoriatic pathogenesis. Consequently, elevated levels are typically found in individuals suffering from conditions like psoriasis. By inhibiting interleukin-23, Skyrizi helps reduce inflammation and slow down the rapid skin cell growth associated with psoriasis, which can significantly ease symptoms such as redness, scaling and itching for patients living with this condition.

What is Otezla?

Otezla, the brand name for apremilast, is a phosphodiesterase 4 (PDE4) inhibitor that works by reducing inflammation within your body. It was first approved by the FDA in 2014. Unlike Skyrizi which targets interleukin-23, a specific protein involved in inflammation, Otezla has a broader mechanism of action since it reduces overall inflammation levels. This means its effect profile is different from Skyrizi's as it does not directly target psoriasis-causing proteins but rather controls general inflammatory responses. Potential side effects include diarrhea and nausea; however, these are usually temporary and ease off with time. Its non-biologic nature makes it an alternative option for patients who do not respond well or are intolerant to typical biologic drugs such as Skyrizi. Furthermore, due to being taken orally instead of via injection like many biologics including Skyrizi, Otezla may be preferred by some patients seeking treatment for moderate-to-severe plaque psoriasis or psoriatic arthritis.

What conditions is Otezla approved to treat?

Otezla has been approved by the FDA for treating a variety of conditions, including:

  • Plaque psoriasis, which is the most common form of psoriasis
  • Psoriatic arthritis, an inflammatory condition that can affect both skin and joints.

How does Otezla help with these illnesses?

Phosphodiesterase 4 (PDE4) is an enzyme that plays a key role in inflammatory responses within the body, often resulting in psoriasis and psoriatic arthritis. Otezla works by inhibiting the action of PDE4, thereby reducing inflammation and associated symptoms. Its effect on cAMP levels may also play roles in its effectiveness as a treatment for these conditions. It does not significantly affect tumor necrosis factor-alpha (TNF-alpha), which is why it's sometimes prescribed when a patient does not respond well to other typical medications used for psoriasis or psoriatic arthritis such as TNF inhibitors like Skyrizi. In some cases, Otezla may be combined with these treatments to more effectively manage symptoms.

How effective are both Skyrizi and Otezla?

Both risankizumab (Skyrizi) and apremilast (Otezla) have proven to be effective in treating moderate-to-severe plaque psoriasis, with similar safety profiles. Risankizumab was approved by the FDA in 2019 while apremilast received approval a few years earlier, in 2014.

Risankizumab and apremilast act on different parts of the immune system. The effectiveness of these two drugs was directly compared in a double-blind clinical trial conducted over 16 weeks; both showed comparable efficacy at significantly reducing symptoms associated with plaque psoriasis. However, patients receiving Skyrizi experienced clearer skin more rapidly than those taking Otezla.

A review study from 2020 indicated that Skyrizi starts showing its effects within four weeks of treatment initiation, has fewer side effects compared to other biologic treatments for psoriasis, and is well-tolerated even among elderly populations or those having multiple health complications. Additionally, Skyrizi has become one of the most widely prescribed drugs for moderate-to-severe plaque psoriasis due to its superior performance at achieving clear skin results.

Despite this impressive profile for Skyrizi, it's important not to underestimate Otezla’s potential as an effective treatment option for moderate-to-severe plaque psoriasis patients who can't tolerate injectable medications like biologics or phototherapy. A meta-analysis published in 2016 suggested that Otezla appears to improve symptoms better than placebo and shows comparable efficacy with many other oral systemic therapies available for treating moderate-to-severe plaque psoriasis.

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At what dose is Skyrizi typically prescribed?

Dosages of Skyrizi for treating moderate to severe plaque psoriasis in adults involve a subcutaneous injection of 150 mg at the start, followed by additional doses at weeks 4 and 16, and then every twelve weeks thereafter. No dosage adjustment is necessary for elderly patients. Unlike oral medications like Otezla, Skyrizi is an injectable medication often administered under the guidance of healthcare professionals. As always, patients should not exceed or adjust the recommended dose without consulting with their doctor first.

At what dose is Otezla typically prescribed?

Otezla treatment is generally initiated at a lower dosage of 10 mg on day one, which can then be gradually increased over the first five days up to a maintenance dose of 30 mg twice daily. It is typically administered without regards to meals and does not require any lab monitoring. The divided doses should ideally be spaced out by approximately 12 hours for optimal results. A maximum dose of 60mg/day divided into two doses of 30 mg each may persist if no significant improvement in symptoms or tolerability issues are observed after several weeks.

What are the most common side effects for Skyrizi?

Side effects commonly associated with Skyrizi include:

  • Upper respiratory infections
  • Fatigue (general weakness and fatigue)
  • Headache, dizziness
  • Rash, potentially at the injection site
  • Fungal skin infections
  • Nausea
  • Muscle pain

On the other hand, Otezla may cause side effects such as:

  • Diarrhea
  • Nausea, vomiting
  • Decreased appetite
  • Respiratory tract infection
  • Abdominal pain
    -Tension headache

It's important to note that both medications may have rare but serious side effects. Always consult your healthcare provider for personalized advice on medication options.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Skyrizi?

While Skyrizi and Otezla are both approved treatments for moderate to severe plaque psoriasis, they do carry potential side effects that patients should watch out for:

  • For Skyrizi, serious infections have been reported: if you experience symptoms such as fever, sweats or chills, muscle aches or coughs that don't go away, shortness of breath or blood in your phlegm – you must seek medical help immediately.
  • Severe allergic reactions including hives; difficulty breathing; swelling of face, lips, tongue or throat may also occur while using Skyrizi. You might experience changes in vision with this medication as well.
  • The use of Otezla has been associated with an increase in depressive symptoms - if feelings of suicide/self-harm emerge during usage contact your doctor without delay.
  • A rapid heartbeat accompanied by sudden dizziness can be seen rarely but signifies a potentially critical situation requiring immediate attention.
  • If any signs indicating low sodium levels such as headache, confusion and weakness surface whilst on either drug regimen discontinue the medicine until after consulting your healthcare provider.
  • Any indication towards muscular rigidity or tremors could signify a severe nervous system reaction which necessitates urgent medical intervention.

What are the most common side effects for Otezla?

Otezla, a medication used for treating psoriasis and psoriatic arthritis, may cause the following side effects:

  • Diarrhea or nausea which usually improves over time
  • Weight loss due to changes in appetite
  • Depression or mood alterations that may need monitoring by healthcare providers
  • Headache
  • Respiratory tract infections leading to stuffy nose or sore throat
  • Increased urination could occur, though it's less common
  • Some patients experience joint pain or insomnia.

Always consult with your healthcare provider if you experience any unusual symptoms while taking Otezla.

Are there any potential serious side effects for Otezla?

Otezla, like any medication, can potentially cause serious side effects. These could include:

  • Signs of an allergic reaction: hives; difficulty breathing; swelling in your face or throat.
  • Severe diarrhoea, nausea or vomiting
  • Weight loss (your doctor should check your weight regularly while you are taking Otezla)
  • Depression or suicidal thoughts
  • Respiratory tract infection symptoms such as fever and cough
  • Headaches

If you experience any of these symptoms while taking Otezla, seek immediate medical attention. If at any point you feel depressed or have suicidal thoughts, stop the medicine immediately and inform your healthcare provider right away. It's also important to note that sudden changes in vision may indicate a more severe problem related to eye inflammation caused by Otezla. Always consult with a healthcare professional regarding any major changes during treatment.

Contraindications for Skyrizi and Otezla?

Both Skyrizi and Otezla, along with most other medications for psoriasis or psoriatic arthritis, may worsen symptoms in some people. If you notice your condition worsening, please seek immediate medical attention.

Neither Skyrizi nor Otezla can be taken if you have been receiving live vaccinations or have a severe infection. Always tell your healthcare provider which medications you are taking; certain drugs will require a period of about 5 weeks to clear from the system to prevent dangerous interactions with Skyrizi and Otezla.

Otezla is specifically not recommended if you have had suicidal thoughts or actions; it has been known to increase these tendencies in patients dealing with depression. On the other hand, while using Skyrizi, one must be careful as it can increase the chances of infections such as tuberculosis (TB), viral infections like chickenpox and herpes, fungal or bacterial infections due to its effect on immune system response.

How much do Skyrizi and Otezla cost?

For the brand name versions of these drugs:

  • The price of two injections (150mg each) of Skyrizi averages around $22,000, which is taken every 12 weeks and works out to approximately $260/day.
  • The price of a month’s supply (60 tablets) of Otezla (30 mg), averages about $3,500, working out to approximately $116/day.

Thus, if you are looking at cost alone, Otezla is less expensive on a per-day treatment basis than Skyrizi. However, please note that cost should not be your primary consideration in determining which medication is right for you - effectiveness and side effects must also be considered.

There are currently no generic versions available for either Skyrizi (risankizumab-rzaa) or Otezla (apremilast), so costs remain high. Always discuss with your healthcare provider what options are best suited for your condition and lifestyle.

Popularity of Skyrizi and Otezla

Risankizumab, marketed under the brand name Skyrizi, is a relatively new entry to the psoriasis treatment market. Approved by the FDA in 2019, it has shown strong efficacy in clinical trials and is increasingly being prescribed by dermatologists for moderate-to-severe plaque psoriasis. Though exact prescription numbers are not available due to its recent introduction, Skyrizi's uptake has been significant given its potential benefits over existing therapies.

Conversely, apremilast (Otezla) was approved by the FDA in 2014 for use in treating moderate-to-severe plaque psoriasis and active psoriatic arthritis. Apremilast accounted for approximately 8% of all prescriptions written for systemic therapy of these conditions as per data from Symphony Health Solutions on total US prescriptions from January 2020 through December 2020. The prevalence of Otezla prescriptions has been generally increasing since its launch but may see competition with newer entrants like Skyrizi.

Conclusion

Both Skyrizi (risankizumab) and Otezla (apremilast) are effective treatments for moderate to severe plaque psoriasis, which have been shown in numerous clinical studies and meta-analyses to be more effective than placebo treatments. They can sometimes be combined, but this is subject to the careful consideration of a physician as they may also interact negatively with one another. Due to their different mechanisms of action, with Skyrizi targeting interleukin-23 (a protein involved in inflammatory processes), and Otezla acting primarily on PDE4 enzyme thereby reducing inflammation within cells, they tend to be prescribed under different circumstances.

Skyrizi is usually administered via injection every 12 weeks after two initial doses at weeks 0 and 4. Meanwhile, Otezla comes in pill form taken orally twice daily making it more convenient for some patients who prefer not having injections.

In terms of cost considerations, both drugs are expensive given that there's no generic alternative available presently although patient assistance programs exist that might help offset these costs. Both Skyrizi and Otezla may require an adjustment period before significant improvements can be seen.

The side effect profile differs between the two drugs; while both are generally well-tolerated, common side effects like upper respiratory infections occur more frequently with Skyrizi while diarrhea or nausea is often reported by users of Otezla. As always when starting any new medication regimen especially those involving immune modulation like these two medications do, patients must closely monitor their symptoms and should seek medical help immediately if they notice any unusual changes or discomfort.

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