Adam Friedman, MD, FAAD

 approval of remibrutinib for adult patients with 

, the HCPLive team spoke with Adam Friedman, MD, on the approval and its significance for patients and clinicians seeking an oral option for CSU.

The approval of remibrutinib, a highly selective Bruton’s tyrosine kinase (BTK) inhibitor, was announced by Novartis following the positive results of the phase 3 REMIX-1 and REMIX-2 studies. Friedman, professor and chair of dermatology at the George Washington University School of Medicine & Health, was asked about these data on remibrutinib and how he sees the medication shifting the landscape of CSU treatment.

Discussing Remibrutinib Following FDA Approval for CSU, With Adam Friedman, MD

“As someone who has been a champion for chronic spontaneous urticaria, the artist formerly known as chronic idiopathic urticaria…I'm really excited about, honestly, any FDA approval for this condition,” Friedman explained. “Because with new approvals, with new options that are hopefully more effective, easier to implement, and that means that we as a specialty have more options to better address these patients.”

Friedman highlighted remibrutinib’s use as a BTK inhibitor, noting that the drug affects patients through the inhibition of the BTK pathway, which prevents histamine release. Consequently, the drug reduces hives and angioedema in patients with CSU and, when implemented with standard-dose antihistamines, can impact both histamine release and histamine receptor activity.

“Now, where it falls in the guidelines, is it going to be on par with [dupilumab and omalizumab], that is TBD, but I think it's really quite amazing that we now will have three options that would be employed very quickly if, after three to four weeks of that, up-dosing of those second generation antihistamines fail,” Friedman said. “Which we see, from the data, is roughly about 50% of these patients. We now will have three options, two injectables, one oral, which means that we can be more personalized to the patient experience.”

The phase 3 findings from REMIX-1 and REMIX-2 had shown that remibrutinib use led to early and substantial reductions in patients’ CSU symptoms. The data also showed disease improvements sustained for up to 52 weeks. Friedman was asked about whether any distinct patient groups may benefit from the drug.

“I think good candidates would truthfully be any patient that has failed the…rapid escalation to fourfold, the recommended dosing of second-generation nonsedating antihistamines,” Friedman explained. “…Now, in terms of patients that we have to think about for whom this wouldn't be appropriate, certainly, until there's data registry data available about pregnancy and lactation, we're going to need to be a little cautious with that. I think there's a more cautious, yet optimistic approach when it comes to any medication.”

Friedman highlighted some existing guidance regarding patients with hepatic insufficiency with respect to concerns of whether someone has some liver impairment. These may be 1 of the only subgroups requiring some minor consideration, though Friedman noted that there is not a lot of current evidence that many patient subpopulations will have any significant concerns.

The quotes contained in this interview summary were edited for the purposes of clarity.

In his financial disclosures, Friedman reported serving as a consultant or advisor for Novartis.

Novartis Pharma AG. Novartis receives FDA approval for Rhapsido® (remibrutinib), the only oral, targeted BTKi treatment for chronic spontaneous urticaria (CSU). GlobeNewswire News Room. Published September 30, 2025. Accessed September 30, 2025. 

https://www.globenewswire.com/news-release/2025/09/30/3159065/0/en/Novartis-receives-FDA-approval-for-Rhapsido-remibrutinib-the-only-oral-targeted-BTKi-treatment-for-chronic-spontaneous-urticaria-CSU.html

Novartis Phase III data confirm sustained efficacy and long-term safety of oral remibrutinib in chronic spontaneous urticaria. Novartis. https://www.novartis.com/news/media-releases/novartis-phase-iii-data-confirm-sustained-efficacy-and-long-term-safety-oral-remibrutinib-chronic-spontaneous-urticaria.

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This interview highlights the significance of remibrutinib's recent FDA approval for clinicians treating chronic spontaneous urticaria.

Dermatology Education Foundation (DERM) 2025 NP/PA CME Conference

, Adam Friedman, MD, from the George Washington University School of Medicine & Health Sciences Department of Dermatology, spoke about off-label approaches to therapeutic challenges in conditions such as lichen planus.

 about the lack of US Food and Drug Administration (FDA)-approved treatments for lichen planus and other lichenoid dermatitides, advocating for off-label use of JAK inhibitors and other treatments like oral retinoids and doxycycline. He also highlighted the potential of JAK inhibitors in autoimmune skin disease treatment, noting conditions such as cutaneous lupus, dermatomyositis, and morphia, noting ongoing clinical studies and personal successes.

Off-Label Approaches to Therapeutic Challenges in Dermatology, with Adam Friedman, MD

“Now, none of these diseases I mentioned have anything meant for them, so that's where we get to be ‘off-label bandits’ and be quite creative,” Friedman said. “I have found with tinkering and trying out different things that in my hands, JAK inhibitors have been the most effective. But historically, the go-tos were things like oral retinoids for moderate to severe disease; most notably, acitretin has the most evidence supporting its use. I've also, for oral lichen planus, low-dose doxycycline. It makes sense because if you think about the initial indication for doxycycline, 20 milligrams, twice a day, which was for chronic gingivitis, I can guarantee you that some of those patients had oral lichen planus, and it just wasn't distinguished. So I think that there are some low-hanging fruit, whether it be topical agents, …whether it be low-dose antibiotics, oral retinoids, or even immunosuppressants. But I think the age of JAK inhibitors in the utilization for lichenoid dermatitis is upon us.”

For dermatomyositis, Friedman emphasized the importance of malignancy screening. In morphia, he highlighted the need for physical therapy to prevent joint deformity. Overall, Friedman encouraged creativity and vigilance for new treatments to improve patient care.

View his full video interview posted above to find out more about these topics. For more from DERM2025, view the latest conference coverage.

The quotes used in this interview summary were edited for clarity.

Friedman has previously reported serving as a consultant to Dermira, Eli Lilly and Company, Encore Dermatology Inc, Exeltis, Galderma, IntraDerm, Johnson and Johnson, Oculus Innovative Sciences, Pfizer Inc, and Sanovaworks.

In this DERM2025 interview, Friedman highlighted some of the discussion points from his presentation on off-label strategies for therapeutic challenges.

In a new interview conducted on-site at the 

, Adam Friedman, MD, spoke with the HCPLive editorial team about managing tinea, also known as 

Friedman, who serves as Professor, Chair of Dermatology, Residency Program Director, Director of Translational Research, and Director of the Supportive Oncodermatology Program in the George Washington University School of Medicine & Health, emphasized the importance of recognizing and treating dermatophytosis, a common but often overlooked group of fungal skin infections, due to the risk of anti-fungal resistance.

Tips on Managing Patients with Fungal Skin Infections, with Adam Friedman, MD

“Dermatophytosis, which encompasses a wide array of clinical cutaneous infections associated with dermatophyte infections, is super common, but is not commonly discussed because it just isn't ‘sexy,’” Friedman said. “And I get it, who wants to talk about fungal infections? But we can't put our heads in the sand. We need to be able to make the right diagnosis, but also consider the potential for anti-fungal resistance if we don't treat the right thing, or if we're not thoughtful about how we use our anti-fungals, of which we unfortunately don't have a huge amount.”

Friedman stressed that clinical inspection alone is insufficient for diagnosis, advocating for the use of potassium hydroxide preps, scrapings, cultures, and biopsies to accurately identify and treat fungal infections.

“I know we pride ourselves as master diagnosticians, but we have proven time and again in the published literature that clinical inspection is not enough,” Friedman explained. “Use my favorite tool of all time, your potassium hydroxide prep. I realize there are some limitations with CLIA certification, but this very simple tool can be the distinguisher between calling something a dermatophyte infection or something primary inflammatory. By defining the disease, you can purposely select the correct treatment regimen, which will then make your patient happy and will prevent fungi from developing resistance to the limited things we have.”

Friedman went on to warn about of the growing resistance to antifungals, particularly azole anti-fungals like econazole and fluconazole. He noted the necessity for careful anti-fungal stewardship, similar to antibacterial stewardship, given the limited number of new anti-fungal treatments available.

“When we think about our anti-fungal armamentarium, most of them are what are called static,” Friedman said. “They are inhibiting an enzyme or something that's needed for cell survival. And when you are inhibiting one thing, the problem is, the fungus among us can become kind of clever and pivot. That, in essence, is where resistance occurs, where one surviving cell has managed to shift the narrative and utilize other machinery to survive. And then it passes that information through its friends…and then we have an anti-fungal that's rendered useless.”

To find out additional information on the subjects covered by Friedman in his session on tinea, view his full video interview posted above. For more on related information, view our 

The quotes contained in this interview description were edited for clarity.

In this interview, Friedman highlights notable points from his DERM 2025 talk on managing patients with tinea.

One of the most difficult struggles many patients with dermatologic diseases face over the course of their condition is chronic pruritus, also known as itch. This topic was covered in a session at the 

Addressing chronic pruritus and managing this symptom of disease was highlighted in a new 

 interview with Adam Friedman, MD, who serves as Professor, Chair of Dermatology, Residency Program Director, Director of Translational Research, and Director of the Supportive Oncodermatology Program in the George Washington University School of Medicine & Health’s Department of Dermatology.

Discussing Strategies to Manage Chronic Itch Among Patients, with Adam Friedman, MD

“I think one of the greatest struggles when it comes to managing a patient with pruritus, which, you have to understand, can be a symptom or a disease unto itself,” Friedman said. “Is it an itch that rashes, meaning you are manipulating the skin by scratching and now create visible change, or is a rash that itches a primary skin disease that is pruritic? That single question will veer you off into 2 very different directions. I would argue a rash that itches is probably a little easier to manage, because there are a plethora of possible things that can be driving the itch with no obvious primary cutaneous issue. With that in mind, you want an organized approach in order to figure out what could be driving disease.”

Friedman spoke about some of the initial focus of labwork, including checking on issues with the liver, kidneys, and thyroid. He went on to discuss pruritus as a potential presenting sign of different forms of malignancy.

“A chest X-ray I would certainly recommend in the right setting,” Friedman explained. “That is definitely one of the key takeaways: do not forget, pruritus can be a presenting sign of many different flavors of malignancy. Probably the best known would be lymphoma, and that's where the chest X-ray comes in. Other key things not to miss know that bullous pemphigoid can just present as pruritus. Anywhere from 10 to 15% of patients can have no skin findings. Also, you never want to be humbled by scabies.”

Friedman later went on to describe tips regarding treatment options for patients suffering from chronic itch.

“We do have OTC and prescription options that are available to us,” Friedman said. “Probably the hottest thing out there is going to be your topical JAK inhibitors and PDE4 inhibitors, both of which have a unique influence on sensory neurons. Systemically, the take-home is that you should take a little from Aisle A, take a little from Aisle B, meaning go after neuropathic or nerve targeting therapies like SSRIs, gabapentinoids, in combination with anti-inflammatories. If it is a mixed picture, fortunately, we have some really amazing systemic agents that are meant to address inflammation but also will hit itch. I mentioned JAK inhibitors before, but we have a litany of biologics that target key cytokines or receptors that drive both inflammation and sensitization of those neurons. So be creative. Ask lots of questions.”

For any additional information on the topics covered by Friedman in his session, view the full video segment posted above this summary. For more, view our 

The quotes used in this interview description were edited for clarity.

This interview with Friedman highlights the takeaways from his DERM 2025 session on managing chronic pruritus in dermatology.

Adam Friedman, MD, FAAD

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