What is risankizumab?
Risankizumab (brand name Skyrizi) is a biologic medication used to treat psoriatic arthritis, plaque psoriasis, and Crohn’s disease. It is a self-injectable medication given under the skin (subcutaneously) at home.
How it works
Risankizumab is a monoclonal antibody that blocks interleukin-23 (IL-23), specifically the p19 subunit. IL-23 is a protein that sits upstream in the inflammatory cascade — it activates the Th17 pathway, which in turn produces IL-17 and other inflammatory signals. By blocking IL-23 at the source, risankizumab is a highly selective treatment that interrupts inflammation while leaving much of the immune system intact.
How it’s given
Risankizumab is self-administered as a subcutaneous injection:
- For psoriatic arthritis and plaque psoriasis: 150 mg (given as two 75 mg injections) at week 0, week 4, then every 12 weeks
- A key advantage of risankizumab is its infrequent dosing — after the initial loading doses, you only need approximately 4 injections per year during maintenance
Your rheumatologist will determine the right dosing schedule for your condition. Risankizumab does not need to be combined with methotrexate.
Storage: Keep risankizumab refrigerated. Allow it to reach room temperature before injecting.
What to expect when starting
- Skin improvement is often noticeable within 4 weeks
- Joint improvement may take 12 to 16 weeks to become apparent
Be patient with joint symptoms — the infrequent dosing schedule means it takes a bit longer to reach full effect, but the convenience of fewer injections is a significant advantage.
Side effects to watch for
Risankizumab is very well-tolerated and has an excellent safety profile. The most common side effects include:
- Upper respiratory infections (cold-like symptoms)
- Headache
- Injection site reactions (mild redness or discomfort)
- Fatigue
Serious side effects are uncommon. Contact your rheumatologist if you develop signs of infection or any symptoms that concern you.
Required screening before starting
Before beginning risankizumab, your rheumatologist will order:
- Tuberculosis (TB) testing — standard for all biologic medications
Things to avoid
- Live vaccines should not be given while on risankizumab. Inactivated vaccines (such as the flu shot) are safe and recommended.
Good to know: Unlike IL-17 inhibitors (such as Cosentyx and Taltz), IL-23 inhibitors like risankizumab are safe for patients with inflammatory bowel disease. In fact, risankizumab is FDA-approved for the treatment of Crohn’s disease. If you have a history of IBD, this is an important advantage.
Frequently asked questions
Only 4 injections a year — is that really enough? Yes. Risankizumab has a long duration of action. The every-12-week maintenance dosing has been shown to be effective in clinical trials for both skin and joint disease.
How is this different from IL-17 inhibitors like Cosentyx or Taltz? IL-23 inhibitors work upstream of IL-17 in the inflammatory pathway. They tend to have an excellent safety profile and, importantly, are safe in patients with inflammatory bowel disease — which IL-17 inhibitors are not. The trade-off is that IL-23 inhibitors may take slightly longer to reach full effect on joint symptoms.
Do I need to take methotrexate with risankizumab? No. Risankizumab is effective on its own.
What if I miss a dose? Inject the missed dose as soon as you remember, then resume your regular schedule. Contact your rheumatologist’s office if you are unsure about timing.
Is risankizumab a long-term medication? Yes. It is typically continued as long as it is working well. Stopping may lead to a return of symptoms.
This handout is for informational purposes only and does not replace the advice of your rheumatologist. Always discuss your specific medical situation, including all medications and health conditions, with your provider before starting or changing any treatment.