Skyrizi (risankizumab) is a biologic medication FDA-approved to treat four inflammatory conditions: moderate-to-severe plaque psoriasis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis. First approved in 2019 for psoriasis, it has since expanded to cover several of the most common autoimmune conditions affecting the skin, joints, and digestive tract.
All four conditions share a common thread: overactive inflammation driven by a protein called interleukin-23 (IL-23). Skyrizi works by blocking the IL-23 protein specifically, which helps shut down the inflammatory chain reaction responsible for symptoms in each condition.
Moderate-to-Severe Plaque Psoriasis
Plaque psoriasis was Skyrizi’s first approved use and remains its most established one. It’s indicated for adults with moderate-to-severe disease who are candidates for systemic therapy or light-based treatment. In clinical terms, these are people whose psoriasis covers enough of their body, or affects visible or sensitive areas enough, that creams and ointments alone aren’t cutting it.
The clinical trial results for psoriasis are notably strong. In head-to-head trials against ustekinumab (Stelara), about 75% of people taking Skyrizi achieved 90% skin clearance by week 16, compared to roughly 42% to 48% on Stelara. By week 52, those numbers climbed: around 81% of Skyrizi patients maintained 90% clearance, and between 56% and 60% reached completely clear skin. In a separate trial against adalimumab (Humira), Skyrizi also showed significantly higher clearance rates at both 16 weeks and 44 weeks.
For psoriasis, Skyrizi is given as a 150 mg injection under the skin at the start of treatment, again at week 4, and then once every 12 weeks. That every-three-months maintenance schedule is one of the least frequent dosing intervals among biologics for psoriasis.
Psoriatic Arthritis
Skyrizi is also approved for active psoriatic arthritis in adults. This condition combines the skin plaques of psoriasis with joint pain, stiffness, and swelling, often in the fingers, toes, lower back, or knees. The dosing schedule is identical to psoriasis: 150 mg injected at weeks 0 and 4, then every 12 weeks.
Crohn’s Disease
For moderately to severely active Crohn’s disease, Skyrizi follows a two-phase approach. The induction phase uses a higher dose, 600 mg delivered by IV infusion over at least one hour, given at weeks 0, 4, and 8. Once induction is complete, patients switch to self-administered injections of 180 mg or 360 mg under the skin every 8 weeks, starting at week 12.
In two large trials (ADVANCE and MOTIVATE), Skyrizi roughly doubled the rate of clinical remission compared to placebo by week 12. In ADVANCE, 45% of patients on Skyrizi reached remission versus about 25% on placebo. Among people who had previously tried and failed other biologics, a historically harder-to-treat group, 43% still achieved remission. Endoscopic response, meaning visible healing of the intestinal lining, was also significantly better: 40% on Skyrizi compared to 12% on placebo in ADVANCE.
Ulcerative Colitis
The newest approved use is for moderately to severely active ulcerative colitis in adults. Like Crohn’s, this condition involves chronic inflammation of the digestive tract, though ulcerative colitis is limited to the colon and rectum.
The dosing here starts with an even higher induction dose: 1,200 mg by IV infusion over at least two hours at weeks 0, 4, and 8. Maintenance then drops to 180 mg or 360 mg by injection every 8 weeks. In the maintenance trial, 45% of patients on the 180 mg dose achieved clinical remission at week 52, compared to 26% on placebo.
How Skyrizi Works
Skyrizi belongs to a class of drugs called IL-23 inhibitors. IL-23 is a signaling protein that plays a central role in driving inflammation in psoriasis, inflammatory bowel disease, and related conditions. It activates certain immune cells that, when overactive, attack healthy tissue in the skin, joints, or gut lining. By binding to a specific part of the IL-23 protein (the p19 subunit), Skyrizi prevents it from triggering that inflammatory cascade.
This targeted approach is more precise than older biologics that block broader parts of the immune system. That selectivity is part of why Skyrizi’s safety profile has generally been favorable in trials, though it does carry some specific considerations.
What to Know Before Starting Treatment
Before beginning Skyrizi, you’ll need to be screened for tuberculosis. Because the drug modifies immune function, a latent TB infection could reactivate during treatment. If you have a history of TB that wasn’t fully treated, your doctor will likely recommend TB therapy before starting Skyrizi. Active TB is a firm contraindication.
You should also be up to date on all recommended vaccinations before your first dose, since live vaccines are not recommended during treatment. For Crohn’s disease specifically, liver enzyme and bilirubin levels are checked before starting and monitored during the induction phase, because the higher IV doses used for gut conditions carry a small risk of liver-related side effects.
Dosing Differences by Condition
One thing worth understanding is that Skyrizi isn’t one-size-fits-all in how it’s given. The condition being treated determines both the dose and the method of delivery.
- Plaque psoriasis and psoriatic arthritis: 150 mg by injection at weeks 0 and 4, then every 12 weeks. No IV infusions needed.
- Crohn’s disease: Three IV infusions of 600 mg during induction (weeks 0, 4, 8), then injections of 180 or 360 mg every 8 weeks for maintenance.
- Ulcerative colitis: Three IV infusions of 1,200 mg during induction (weeks 0, 4, 8), then injections of 180 or 360 mg every 8 weeks for maintenance.
The skin and joint conditions use a lower dose because inflammation in those areas responds to less medication. Gut inflammation requires higher initial doses to reach therapeutic levels in the intestinal tissue, which is why induction for Crohn’s and ulcerative colitis starts with IV infusions at a clinic or infusion center. Once the disease is under better control, patients transition to self-injections at home.
Patient Support and Access
AbbVie, the company behind Skyrizi, runs a patient support program called Skyrizi Complete. It offers one-on-one nurse support for questions about the medication, help navigating insurance coverage and prior authorizations, injection training, and a companion app for dose reminders and tracking. A co-pay savings card is available for commercially insured patients age 63 or younger, though it does not apply to those covered by Medicare, Medicaid, or other government programs.