Skyrizi vs Sotyktu
Skyrizi is an injection you give yourself four times a year. It clears skin more completely than Sotyktu does. Sotyktu is a tablet you take once a day. In the one trial that compared them head to head, 57% of people on Skyrizi had skin at least 90% clear at four months, against 23% on Sotyktu.
What you do
Two starter doses four weeks apart, then one every 12 weeks. You can do it yourself at home with a pen or a prefilled syringe.
Swallowed, with or without food. No needles and no fridge.
How well it clears skin
In the head-to-head trial, 57% of people on Skyrizi had skin at least 90% clear at four months, and 28% were completely clear.
23% reached the same 90% mark in that trial, and 7% were completely clear. Plenty of people still get a good result, just less often.
How long until it works
Most people see change by the first month. The result keeps building to about week 16.
Improvement starts in the first month or two and also builds to about week 16.
What it will not do
Psoriasis returns if you stop. It also does nothing for a plaque on the day, so many people keep a cream for stubborn patches.
Stopping the tablet lets psoriasis come back. It is not a quick rescue for a bad flare.
Blood tests and monitoring
A tuberculosis check before you start, and not much after that.
Liver tests, cholesterol, blood counts and a muscle enzyme called CPK are checked before you start and from time to time afterwards.
The downside
Colds, sinus infections, headache and a sore injection site are the common complaints. It damps down part of the immune system, so infections are the main thing to watch.
Colds, sore throat, sinus infections, cold sores, mouth ulcers, acne and inflamed hair follicles are the common complaints. It also damps down part of the immune response, so infections matter here too.
How often you think about it
Once the schedule is running, it is four dates in a calendar.
A tablet is easy, but it only works if you take it. Missed days show up in the skin.
Cost
An injected drug is sometimes billed differently from a tablet, which can change your share.
Tablets normally go through the pharmacy benefit.
The at-home or drugstore version
A biologic is a large protein made in living cells, which is why it has to be injected. Stomach acid would destroy it, so no pill version of this drug is possible.
Sotyktu is a prescription tablet with required blood tests. Coal tar and salicylic acid shampoos and hydrocortisone cream help a small patch, and neither reaches psoriasis covering large areas.
The real choice is a pill or an injection
The tablet wins on convenience: No needles, no fridge, no injection days. For someone who genuinely dislikes needles, that is the whole decision, and it is a reasonable one.
The injection wins on how clear your skin gets: In the head-to-head trial, more than twice as many people on Skyrizi reached almost-clear skin. If your goal is skin you never have to think about, that gap is the point.
Four doses a year is its own kind of convenience: People assume an injection is more effort than a tablet. Once the two starter doses are done, Skyrizi is four appointments with yourself across a whole year. Sotyktu is 365 tablets.
How each one works
Skyrizi blocks one immune signal called IL-23: IL-23 sits near the top of the chain that drives psoriasis plaques. A biologic is a drug made from a protein rather than a chemical, and this one is built to block that single signal and little else.
Sotyktu blocks an enzyme called TYK2 inside the cell: That turns down several psoriasis signals at once, including IL-23, but from further down the chain. It is a small chemical, which is what makes a swallowable tablet possible in the first place.
What each one asks of you
Skyrizi asks you to inject yourself and then forget about it: The pen is designed for home use, and the gap between doses is three months. Most of the effort is at the start.
Sotyktu asks you to remember it every day and to give blood now and then: The tablet itself is simple. The monitoring is the part people underestimate, and it is not optional.
Before you decide
How clear do you want to be, and how clear is realistic on each?
Would you rather inject yourself four times a year or take a tablet daily?
Are you comfortable with regular blood tests?
Do you also have joint pain? Both are used in psoriatic arthritis, and that can steer the choice.
What does your insurance want you to try first?
