Andrea Nguyen, PA-C, MS

 (CIndU) has long lacked approved therapies, leaving clinicians to rely on up-dosed antihistamines and off-label agents for a frequently persistent disease.

In this HCPLive Special Report, Andrea Nguyen, DMSc, MPAS, PA-C, of First OC Dermatology, spoke with Adam Friedman, MD, of George Washington University School of Medicine and Health Sciences, about how the approval of remibrutinib (Rhapsido),  an oral Bruton tyrosine kinase (BTK) inhibitor, for adults with symptomatic dermographism inadequately controlled by H1 antihistamines.

Experts discuss remibrutinib, the first FDA-approved therapy for symptomatic dermographism, and its role in chronic inducible urticaria.

Special Report: Remibrutinib, an Oral BTKi, for Chronic Inducible Urticaria

In the phase 3 RemIND trial, 115 adults with a mean disease duration of 5.8 years received remibrutinib 25 mg or placebo twice daily. At week 12, 29.3% (17/58) vs 14.0% (8/57) achieved a complete response on the Total Fric Score (P = .0229). Responses emerged by week 2, persisted through week 24, and held regardless of baseline total IgE.

A complete response means no wheal after standardized friction provocation, a stringent bar in easily provoked skin. This consistency across IgE levels supports broad applicability, unlike CSU, where IgE can predict response to omalizumab (Xolair).

Remibrutinib blocks BTK downstream of high-affinity IgE receptor cross-linking, halting mast cell degranulation whether activation is IgE- or IgG-mediated. Its efficacy in dermographism also suggests a BTK role in inducible mast cell activation.

Safety mirrored the REMIX trials in CSU, where petechiae occurred more often with remibrutinib than placebo (3.8% vs 0.3%).

 Mild mucocutaneous bleeding reflects BTK's role in platelet function, and no routine laboratory monitoring is required.

Collectively, the approval gives clinicians evidence-based footing in a long-neglected condition. Data from cold and cholinergic urticaria cohorts may extend the reach of BTK inhibition further.

Metz M, Giménez-Arnau A, Hide M, et al. Remibrutinib in chronic spontaneous urticaria. 

Novartis. Novartis Rhapsido (remibrutinib) receives FDA approval as first treatment for symptomatic dermographism (SD), expanding its use beyond chronic spontaneous urticaria (CSU). Published October 7, 2026. Accessed October 7, 2026. 

https://www.novartis.com/us-en/news/media-releases/novartis-rhapsido-remibrutinib-receives-fda-approval-first-treatment-symptomatic-dermographism-sd-expanding-its-use-beyond-chronic-spontaneous-urticaria-csu

Videos

Andrea Nguyen, PA, shares her clinical pearls on taking care of patients with AD.

Clinical Pearls on AD Management

This is a video synopsis/summary of a panel discussion involving Melodie Young, NP, and Andrea Nguyen, PA.

In this segment, the discussion centers on providing advice and encouragement for healthcare professionals, particularly those entering the field or adjusting their approach to adhere to newer guidelines for managing atopic dermatitis (AD). The speakers acknowledge the increasing prevalence of AD, emphasizing the substantial number of patients with significant body involvement who may require more than just topical therapies.

The advice includes a systematic approach to learning about the various therapeutic categories, such as monoclonal antibodies, biologics, oral Jack inhibitors, and topicals. The recommendation is to start with a focused exploration of one category to build confidence before expanding knowledge across all therapy options. Anticipating continuous development in the next 5 to 10 years, there is emphasis on creating an efficient workflow and clinic template to streamline the prescription process for these complex therapies.

The conversation concludes with the suggestion of possible future discussions on using telemedicine for AD management, highlighting its effectiveness in treating chronic diseases like AD.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.

Clinical Pearls on AD Management 

Melodie Young NP and Andrea Nguyen, PA look into the future of AD management.

The Future Of AD Treatment

In this conversation, the speakers reflect on the significant advancements in the management of atopic dermatitis (AD) over the past 15 years. They express gratitude for the current plethora of therapeutic options, a scenario that was unforeseen in the past. The discussion includes anticipation of potential new topical agents entering the AD market and the excitement surrounding evolving treatment options.

Looking ahead to the next decade, the speakers share their expectations for further refinement of therapeutic products, emphasizing the uniqueness of individual immune responses. They discuss the positive impact of personalized medicine, where patients can switch between different therapeutic agents based on their specific responses.

The conversation highlights the potential shift in treatment outcomes, aiming for higher efficacy numbers, particularly EASI (eczema area and severity index)90 responses, with a combination of systemic agents and advanced topical therapies. The speakers express hope for achieving a level of precision in treatment similar to that seen in psoriasis care, tailoring interventions to target-specific areas of involvement.

The discussion concludes with considerations for intervening earlier in familial cases and encouraging proactive adherence to updated care guidelines. The speakers emphasize the ongoing importance of clinical trials and research in understanding and managing AD, acknowledging the significance of dedicated patient care in dealing with this chronic condition.

The Future of AD Treatment 

Physician assistant Andera Nguyen shares her experience on combination therapy and class switching.

Combination Therapy For AD

In this discussion, the speakers delve into the considerations around combination therapy for treating patients with a chronic skin condition. The conversation mentions avoiding the combination of topical and systemic JAK (Janus kinase) inhibitors but highlights the flexibility to mix and match various therapies, including emerging topical options. The decision to introduce a combination of therapies is patient-specific and lacks a 1-size-fits-all approach, emphasizing the need for individualized care.

The approach outlined involves giving injectable agents time to show maximum disease control before considering alternative treatments. There's also a discussion about integrating topical therapies alongside injectables to accelerate therapeutic benefits. With oral JAK inhibitors, the typical assessment period for efficacy is within the initial 8 to 16 weeks. The importance of considering patients' life circumstances is emphasized, as external factors can influence disease flares, and practitioners must differentiate between medication effectiveness and external triggers.

The conversation acknowledges the evolving landscape in dermatology, noting the expanded options available to switch therapeutic agents based on patient response. Changing expectations are underscored, anticipating positive outcomes with current treatments and emphasizing the need for detective work if patients do not respond as expected, including addressing issues like inconsistent injection schedules.

Andrea Nguyen, PA-C, MS

Articles