Introduction
Otezla (apremilast) and Stelara (ustekinumab) are prescription drugs used to treat a skin condition called psoriasis. This article explains what psoriasis is and highlights the differences between these two drugs. If your doctor has diagnosed you with psoriasis, this information may help you decide if Otezla or Stelara may be right for you.
Psoriasis is a chronic (long-term) disease that affects your skin. There are two types of psoriasis: plaque psoriasis and psoriatic arthritis. With plaque psoriasis, skin cells build up and form red or silvery scales called plaques. These plaques are patches of skin that are dry, itchy, and sometimes painful. Psoriatic arthritis has these same skin effects plus swelling and pain in the joints.
The cause of psoriasis isn’t clear, but it’s most likely caused by a problem with certain blood cells. These cells are called T-lymphocytes (or T-cells) and they’re part of your immune system. They typically attack germs such as bacteria and viruses. With psoriasis, though, T-cells wrongly attack your skin cells. In response, your body produces new skin cells faster than normal, causing layers of skin to build up. Your immune system also damages your joints with psoriatic arthritis.
Otezla and Stelara are both used to treat plaque psoriasis and psoriatic arthritis. This table includes basic information about each of these drugs.
Drug features
| Brand name | Otezla | Stelara |
| Use | Treatment of: • psoriatic arthritis • plaque psoriasis | Treatment of: • psoriatic arthritis • plaque psoriasis |
| Drug | Apremilast | Ustekinumab |
| Generic version | Not available | Not available |
| Form | Oral tablet | Subcutaneous (below the skin) injection |
| Strengths | • 10mg • 20 mg • 30 mg | • 45 g/0.5 mL in a single-use prefilled syringe • 90 mg/mL in a single-use prefilled syringe • 45 mg/0.5 mL in a single-use vial • 90 mg/mL in a single-use vial |
| Typical dosage | One tablet twice daily | • First two doses: One injection every 4 weeks* • Additional doses: One injection every 12 weeks |
| Typical length of treatment | Can be used for long-term treatment | Can be used for long-term treatment |
| Storage requirements | Should be stored at room temperature below 86°F (30°C) | Should be stored in a refrigerator at temperatures between 36°F and 46°F (2°C and 8°C) |
*Self-injection may be possible after training from your healthcare provider.
Stelara and Otezla are both specialtydrugs, which are high-cost medications used to treat certain chronic conditions. Usually, only large specialty pharmacies stock specialty drugs.
Both of these drugs are expensive. However, at the time this article was written, the estimated monthly cost for Stelara was quite a bit higher than for Otezla (see www.goodrx.com).
Your insurance may not cover either of these drugs. Ask your pharmacist to check your insurance to see if it covers these drugs. If it doesn’t, talk with your doctor about other payment options. For instance, the drugs’ manufacturers may offer programs that help cover the cost of the drugs.
Like all drugs, Otezla and Stelara can cause side effects. Some of these are more common and may go away after a few days. Others are more serious and can require medical care. You should consider all side effects when deciding if a drug is a good choice for you.
The list below contains examples of side effects of Otezla or Stelara.
Side effects
| Otezla | Stelara | |
| More common side effects | • diarrhea • nausea • headache • respiratory infections • weight loss | • infections in your nose or throat • headache • respiratory infections • tiredness |
| Serious side effects | • depression • mood changes • thoughts of suicide | • allergic reaction, with symptoms such as: • wheezing • tightness in your throat • trouble breathing • return of past infections, such as bacterial, fungal, or viral infections • increased risk of skin cancer • rare: reversible posterior leukoencephalopathy, a neurological disease that can cause death |
An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. This can help your doctor prevent possible interactions.
The chart below lists examples of drugs that may interact with Otezla or Stelara.
Drug interactions
| Otezla | Stelara |
| • medications such as rifampin, which affect how your body processes other drugs • bosentan • dabrafenib • osimertinib • siltuximab • tocilizumab • St. John’s wort | • live vaccines, such as the flu vaccine • medications that affect the immune system, including: • topical tacrolimus • pimecrolimus • infliximab • natalizumab • belimumab • tofacitinib • roflumilast • trastuzumab • phototherapy (the use of light to treat psoriasis) |
Your overall health is a factor when considering if a drug is a good choice for you. For instance, a particular drug may worsen a certain condition or disease you have. Below are medical conditions you should discuss with your doctor before taking Otezla or Stelara.
Medical conditions to discuss with your doctor
| Otezla | Stelara |
| • Kidney problems. If you have severe kidney problems, you may need a different dosage of Otezla. • Depression. Otezla can make your depression worse or cause suicidal thoughts or other mood changes. | • Infections. You should not take Stelara while you have an active infection. Stelara may make the infection worse. • Tuberculosis. You should not take Stelara if you have tuberculosis. This medication may make your tuberculosis worse or make a past tuberculosis infection become symptomatic (active) again. |
Psoriasis treatment may have an effect on pregnancy or breastfeeding. The chart below answers some questions you may have if you’re pregnant or breastfeeding.
Pregnancy and breastfeeding
| Otezla | Stelara | |
| What pregnancy category does the drug belong to? | Category C | Category B |
| What does the pregnancy research show? | Research in animals has shown adverse effects to the fetus when the mother takes the drug. | Research in animals has not shown a risk to the fetus when the mother takes the drug. |
| Does the drug pass into breast milk? | Unknown | Likely |
| What does the breastfeeding research show? | It’s likely best to avoid breastfeeding while taking this drug. | It’s not known what kind of effect the drug would have on the child. |
If you’re pregnant or breastfeeding, talk with your doctor to see if it’s safe for you to take Otezla or Stelara.
Of course, an important factor to think about when choosing a drug is how well it works. In clinical trials*, Stelara proved to be slightly more effective than Otezla when used to treat both types of psoriasis.
The chart below details what the clinical trials of Otezla and Stelara found. (You can find the original data from these clinical trials in section 14 of the prescribing information for Otezla and Stelara.)
Effectiveness
| Otezla | Stelara | |
| Psoriatic arthritis: Treatment of joint pain and stiffness | Otezla (used with DMARD† treatment): more than one-third of patients had a 20% improvement | Stelara (used with DMARD† treatment in about half of patients): • about one-half of patients had a 20% improvement • about one-fourth of patients had a 50% improvement |
| Plaque psoriasis: Treatment of skin plaques | About one-third of patients had clearer skin or fewer plaques. | About one-half to three-quarters of patients had clearer skin or fewer plaques. |
*Clinical trials follow many different formats. They examine patient groups that vary in age, disease condition, lifestyle, and other factors. That means the results of any one trial may not relate directly to your experience with a certain drug. If you have questions about the results of these trials or any other clinical trials, discuss them with your doctor.
†DMARD stands for disease-modifying anti-rheumatic drug. These drugs may be used with Otezla or Stelara to treat psoriatic arthritis.
When comparing Otezla and Stelara, think about their many differences and how they might affect you. To help you decide if Otezla, Stelara, or another psoriasis medication is right for you, talk with your doctor. Discuss the information in this article as well as your full health history. Your doctor can help you find a psoriasis treatment that’s both effective and appropriate for your health needs.