Is it safe to use Skyrizi (risankizumab) and meloxicam together?

Safety of Using Skyrizi (Risankizumab) and Meloxicam Together

There is no evidence of significant drug interactions between Skyrizi (risankizumab) and meloxicam, making this combination generally safe to use together.

Understanding the Medications

Skyrizi (Risankizumab)

• Risankizumab is a humanized IgG1 monoclonal antibody that selectively inhibits IL-23 by binding to the p19 subunit 1
• FDA-approved for the treatment of moderate to severe plaque psoriasis, Crohn's disease, and ulcerative colitis 2, 3
• Works through a different mechanism than many other immunosuppressants by targeting the IL-23 pathway specifically 1

Meloxicam

• Non-steroidal anti-inflammatory drug (NSAID) of the oxicam class
• Preferential inhibitor of COX-2 with anti-inflammatory, analgesic, and antipyretic properties
• Has a plasma half-life of approximately 20 hours, allowing for once-daily dosing 4
• Primarily used for osteoarthritis and rheumatoid arthritis 4

Drug Interaction Analysis

Metabolic Pathways

• Risankizumab is not metabolized through cytochrome P450 enzymes and does not affect these pathways 5
• Meloxicam is metabolized by CYP2C9 and CYP3A4 4
• There is no evidence of risankizumab inhibiting or inducing these enzymes, unlike some small molecule inhibitors that can affect drug metabolism 5

Transporter Proteins

• Risankizumab is not known to be a substrate or inhibitor of P-gp or BCRP transporters 5
• Unlike some small molecule drugs that can inhibit transporter proteins (as described for other medications), risankizumab as a monoclonal antibody does not interact with these transporters 5

Clinical Considerations

Efficacy

• Both medications can be used concurrently without compromising the efficacy of either drug 5
• Risankizumab has demonstrated effectiveness in inflammatory conditions regardless of concomitant medication use 6

Safety Profile

• As an IL-23 inhibitor, risankizumab may have a lower rate of infectious complications compared to TNF antagonists 7
• No increased safety concerns have been identified when risankizumab is used with other medications 6
• Meloxicam carries the standard NSAID risks of gastrointestinal, cardiovascular, and renal adverse effects 4

Special Populations

Patients with Inflammatory Bowel Disease

• Risankizumab is approved for Crohn's disease and ulcerative colitis 3
• NSAIDs like meloxicam should be used with caution in patients with inflammatory bowel disease due to potential for disease exacerbation, but this is independent of risankizumab use 4

Patients with Immune-Mediated Disorders

• For patients with concurrent immune-mediated disorders requiring multiple agents, there is no contraindication to using risankizumab with meloxicam 5

Monitoring Recommendations

• Regular monitoring for NSAID-related adverse effects (gastrointestinal, renal, cardiovascular) should continue as usual 4
• No additional monitoring is required specifically for the combination of these two medications 5

Conclusion

The combination of Skyrizi (risankizumab) and meloxicam does not present any known significant drug interactions. Unlike small molecule inhibitors that may affect drug metabolism or transport proteins, risankizumab as a monoclonal antibody targeting IL-23 does not interfere with the metabolic pathways of meloxicam. Both medications can be safely used together with standard monitoring for their individual adverse effect profiles.