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Skyrizi vs Humira
Introduction
For patients with chronic inflammatory conditions such as psoriasis or rheumatoid arthritis, certain biologic drugs that target specific parts of the immune system can help in controlling inflammation and managing symptoms. Skyrizi and Humira are two such drugs that are commonly prescribed for these conditions. They each act on different proteins involved in the body's immune response but both have been shown to effectively reduce inflammation and improve quality of life for many patients. Skyrizi works by targeting interleukin-23 (IL-23), a protein that plays a key role in promoting inflammation, while Humira is classified as a TNF-alpha inhibitor, primarily affecting tumor necrosis factor alpha (TNFα), another pro-inflammatory protein.
What is Skyrizi?
Risankizumab, marketed as Skyrizi, is a relatively recent addition to the class of drugs known as interleukin inhibitors and was first approved by the FDA in 2019. It represents a significant advancement from earlier biologic treatments for conditions like psoriasis, such as adalimumab (Humira). Skyrizi works by selectively targeting IL-23, an inflammatory protein involved in the pathogenesis of psoriasis. This precise action enables it to reduce inflammation effectively without affecting other immune responses significantly.
On the other hand, Humira has been around longer - since 2002 - and works slightly differently; it inhibits TNF-alpha (Tumor Necrosis Factor Alpha), another protein that plays a role in systemic inflammation. However, because TNF-alpha is involved in multiple immune processes, blocking it can have broader effects on the body's immunity compared to targeting specific interleukins.
Skyrizi requires less frequent dosing than Humira – every twelve weeks after initial doses at baseline and week four versus every two weeks with Humira. This difference could potentially improve patient adherence and quality of life. Both drugs have proven effective for treating moderate-to-severe plaque psoriasis but individual response rates may vary.
What conditions is Skyrizi approved to treat?
Skyrizi is approved for the treatment of various conditions including:
- Moderate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy
- Psoriatic arthritis (in combination with methotrexate)
Humira, on the other hand, has a broader range of applications. It is used in the treatment of:
- Rheumatoid arthritis
- Juvenile Idiopathic Arthritis
- Psoriatic Arthritis
- Ankylosing spondylitis -Moderate to severe Crohn's disease and Ulcerative colitis. These two drugs have different mechanisms and side-effects profiles which should be considered when choosing between them.
How does Skyrizi help with these illnesses?
Skyrizi helps to manage psoriasis by targeting interleukin-23, a protein that plays a crucial role in inflammation and immune response. It does this by binding to the p19 subunit of interleukin-23, thus inhibiting its interaction with the cell surface receptor and impeding the inflammatory response. Interleukin-23 is a cytokine, a type of protein that acts as a messenger in the immune system, playing an important role in cell signaling and the coordination of immune responses. It is thought that individuals with psoriasis have an overactive response to interleukin-23, which leads to excessive skin cell production. By blocking interleukin-23, Skyrizi can limit the negative effects of psoriasis, helping patients manage their condition and stabilize their skin health.
What is Humira?
Humira, a brand name for Adalimumab, is a TNF-alpha inhibitor which means it acts by blocking the action of tumor necrosis factor alpha (TNFα), a substance in the body that causes inflammation. It was first approved by the FDA in 2002. Unlike Skyrizi, Humira does not inhibit interleukin-23 but focuses on TNFα instead. Its unique mechanism of action means its side effects are quite different from those of Skyrizi; it could potentially cause serious infections due to reduction in immunity and may also cause liver problems. However, Humira has shown effectiveness against various inflammatory conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease among others. The targeted action on TNFα can be beneficial especially for patients who do not respond well to other typical drugs used to treat these conditions like Skyrizi.
What conditions is Humira approved to treat?
Humira, a widely recognized biologic medication, is approved for treating a variety of autoimmune conditions including:
- Rheumatoid arthritis (RA)
- Plaque psoriasis
- Crohn's disease
- Ulcerative colitis
- Ankylosing spondylitis
It functions by inhibiting tumor necrosis factor-alpha (TNFα), an inflammatory substance in the body.
How does Humira help with these illnesses?
Tumor necrosis factor (TNF) is a cytokine involved in systemic inflammation and is found to be increased in various inflammatory conditions such as rheumatoid arthritis and psoriasis. Humira, a TNF inhibitor, works by reducing the levels of TNF in the body, thereby suppressing the inflammatory response and alleviating the symptoms of these conditions. Its action on other cytokines may also play roles in the action of Humira as an anti-inflammatory agent. Since it is a systemic immunosuppressant, it is often prescribed when a patient does not respond well to the “typical” localized treatment methods (such as topical corticosteroids), or may be combined with other therapies. While Skyrizi also targets the inflammatory pathway, it does so at a different point - by inhibiting interleukin 23, another cytokine involved in the inflammatory response.
How effective are both Skyrizi and Humira?
Risankizumab (Skyrizi) and adalimumab (Humira) are both approved by the FDA for treating moderate to severe plaque psoriasis, although they were introduced into the market nearly two decades apart. They work via different mechanisms; while Humira is a TNF inhibitor, Skyrizi targets IL-23 specifically.
A direct comparison of these medications was conducted in a double-blind clinical trial called IMMvent in 2018. This study showed that Skyrizi demonstrated superior efficacy compared to Humira at week 16 and maintained this superiority up to week 44 in terms of PASI90 responses (a measure indicating at least 90% improvement in the Psoriasis Area Severity Index), as well as improved skin clearance.
A review published in Therapeutic Advances in Chronic Disease reports that Risankizumab has been shown effective from first weeks of treatment with high rates of skin clearance through one year. The side effect profile seems generally favorable relative to other biologic drugs used for plaque psoriasis, though long-term data is still being collected given its relatively recent approval. As an IL-23 inhibitor developed more recently than older classes like TNF inhibitors, there's less historical data on its effectiveness but emerging evidence suggests it may offer advantages over older options including potentially better safety and tolerability.
Adalimumab has been widely studied since its introduction and remains a key option for managing conditions like rheumatoid arthritis, IBDs as well as psoriasis. While generally safe and effective, it can be associated with injection site reactions or increased susceptibility to infections due to immune system suppression. Furthermore, some patients may develop antibodies against adalimumab which can reduce drug efficacy over time.
Nonetheless, choosing between these treatments often depends on individual patient factors such as disease severity, comorbidities or personal preference after considering potential risks and benefits associated each medication’s mechanism of action.
At what dose is Skyrizi typically prescribed?
Injectable doses of Skyrizi are typically 150 mg administered at week 0, then again at week 4, and every twelve weeks thereafter. Studies have shown that this dosage is sufficient for treating moderate to severe plaque psoriasis in most adults. Children's usage and dose should be determined by a doctor. The dosage may be adjusted based on the response after a few injections but should not exceed the recommended maximum limit of 150 mg per session.
Conversely, Humira is typically injected under the skin once every other week for patients with psoriasis. However, some conditions might require weekly injections or higher dosages depending on severity and patient response to treatment.
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At what dose is Humira typically prescribed?
Humira therapy for rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis typically begins with a loading dose of 80 mg. After that initial dosage, treatment usually continues at 40 mg every other week. For patients who do not respond adequately to this regimen after a few weeks, the frequency can be increased to 40mg weekly administration. However, in severe cases such as moderate-to-severe Crohn's disease or ulcerative colitis in adults and children aged six years or older, the dosing regimen may start with an initial dose of up to 160mg (four injections in one day or two injections per day for two consecutive days), followed by 80mg two weeks later. Subsequent doses are then given every other week at a rate of 40mg per injection.
What are the most common side effects for Skyrizi?
Potential common side effects of Skyrizi include:
- Upper respiratory infections
- Headache
- Fatigue (general weakness and tiredness)
- Injection site reactions (redness, itching, swelling or pain at the injection site)
- Fungal skin infections
On the other hand, common side effects reported with Humira include:
- Infections such as sinusitis (inflammation of the sinuses) and flu syndrome
- Headaches
- Rash
- Nausea -Asthenia (general weakness and fatigue) -Diarrhea
It's important to note that while both medications have their own set of potential side effects, not everyone taking these medications will experience them. It always depends on individual reactions to a drug. Always consult your healthcare provider for personalized advice based on your specific health condition.
Are there any potential serious side effects for Skyrizi?
Skyrizi and Humira, both used to treat conditions like psoriasis and rheumatoid arthritis, can have serious side effects in rare cases. These may include:
- Signs of a severe allergic reaction such as difficulty breathing; swelling of the face or throat; skin rash, itching or hives
- Symptoms indicative of infections: fever, sweats or chills; muscle aches; coughing, shortness of breath or trouble breathing; blood in phlegm; weight loss; warm, red or painful areas on the skin
- Changes in vision such as blurry vision or other vision changes
- Rapid heart rate, feeling faint
- Lower than normal sodium levels - headache, confusion, slurred speech, severe weakness
- Severe reactions affecting your nervous system - stiff muscles coupled with high fever (akin to neuroleptic malignant syndrome), tremors.
If you experience any of these symptoms while taking either Skyrizi or Humira it is important that you seek immediate medical attention.
What are the most common side effects for Humira?
Humira, a commonly prescribed medication for conditions like rheumatoid arthritis and psoriasis, can lead to a variety of side effects such as:
- Redness, itching or bruising where the injection was given
- Headache and dizziness
- Sinus infection leading to stuffy nose, sore throat or ear pain
- Abdominal discomfort including stomach pain, nausea and constipation
- Rash or other skin problems
- Muscular weakness or joint pain
- Increased frequency of urination
- Unusual tiredness leading to sleep issues Uncommon but serious side effects may include fast heartbeat, weight loss due to loss of appetite. It is also important to note that Humira has been linked with nervous system disorders resulting in confusion or agitation. Always discuss potential side effects with your healthcare provider before starting any new treatment regimen.
Are there any potential serious side effects for Humira?
While Humira is generally well-tolerated, some patients may experience severe side effects. These can include:
- Signs of an allergic reaction such as difficulty breathing or swallowing, hives, itching, fever, swollen glands in the neck
- Skin reactions like a rash that's red or purple and sometimes spreads across larger areas with blistering and peeling
- Neurological symptoms including confusion and changes in mood or behavior
- Vision problems including blurred vision, tunnel vision, eye pain or swelling or seeing halos around lights
- Cardiovascular symptoms such as rapid heartbeats
- Immune system response leading to lupus-like syndrome; signs can include chest discomfort or pain that does not go away, shortness of breath, joint pain, rash on the cheeks or arms that worsens in the sun.
If you notice any of these symptoms while taking Humira for your condition (such as rheumatoid arthritis), it's crucial to seek immediate medical help.
Contraindications for Skyrizi and Humira?
Both Skyrizi and Humira, like many other biologic medications, may lower your body's ability to fight infections. If you notice signs of infection such as fever, chills, fatigue or rapid breathing while taking either drug, please seek immediate medical attention.
Neither Skyrizi nor Humira should be taken if you are dealing with an active infection or have been exposed to tuberculosis (TB). Always tell your physician about any past or current health conditions; TB exposure will require treatment before starting these drugs to prevent activation of latent bacteria.
Before initiating therapy with either Skyrizi or Humira, it is crucial that patients get tested for TB and hepatitis b due to the increased risk of reactivation during treatment. Also remember that live vaccines should not be given concurrently with these medications due their immunosuppressive effects.
How much do Skyrizi and Humira cost?
For the brand name versions of these drugs:
- The price of two injections (150 mg each) of Skyrizi averages around $22,000, which works out to about $366/day for an average dosage schedule of once every two months.
- The price for a one-month supply (4 pre-filled syringes) of Humira (40mg each) is approximately $5,500, so it equates to roughly $183/day.
Therefore, if you are on a typical dosing regimen for either drug i.e., 300 mg/dose every 8 weeks for Skyrizi or 40 mg/week for Humira then brand-name Humira is less expensive on a per-day treatment basis. However cost should not be the primary factor in determining which medication is right choice. It's essential to consider other aspects such as effectiveness and side effects.
Unfortunately, there are no generic versions available presently for both Skyrizi (risankizumab-rzaa) and Humira (adalimumab), hence costs remain significantly high. Both medications are considered specialty drugs used primarily in the treatment of severe conditions such as psoriasis and rheumatoid arthritis among others.
Popularity of Skyrizi and Humira
Risankizumab, marketed under the brand name Skyrizi, is a relatively new treatment option for moderate to severe plaque psoriasis. It was approved by the FDA in 2019 and has been gaining traction since then due to its efficacy and dosage schedule of once every 12 weeks after two initial doses at weeks 0 and 4. Although exact prescription numbers are not readily available due to its novelty, studies have shown that about three-quarters of patients achieve clear or almost clear skin within one year of starting Skyrizi.
On the other hand, Adalimumab (brand name Humira) has long been a staple treatment for multiple autoimmune disorders including moderate to severe chronic plaque psoriasis. This biologic medication was prescribed more than 11 million times in the US alone in 2020. Despite being an effective drug with proven track record over many years, Humira's weekly injection schedule might be less attractive compared to Skyrizi's quarterly regimen.
Conclusion
Both Skyrizi (risankizumab) and Humira (adalimumab) are medications used to treat certain autoimmune conditions, including psoriasis, with a long history of usage backed by multiple clinical studies showing their effectiveness over placebo treatments. Both work by modulating the immune response: Skyrizi does this by inhibiting interleukin-23, while Humira targets tumor necrosis factor-alpha.
Humira is often considered as a first-line treatment option for moderate to severe cases due to its broader range of approved indications. On the other hand, Skyrizi might be chosen if patients did not respond well or tolerate TNF inhibitors like Humira or have contraindications against using such drugs.
Neither drug has a generic form available yet which can make them expensive especially for those paying out-of-pocket. It may take some time after starting either medication before beneficial effects are noticed due to their mechanisms of action.
The side effect profile is similar between these two drugs and both are generally well-tolerated but they do carry serious risks such as infections due to immune system suppression. Patients should therefore monitor their health closely when starting treatment and seek immediate medical attention if they notice signs of infection or any unusual symptoms.