Jason Hawkes, MD, MS

Personalization of CSU Care With Advanced Therapies

Jason Hawkes, MD, MS, a board-certified dermatologist and associate professor of Dermatology at the University of California Davis, predicts that the management of CSU—and other inflammatory skin conditions—will increasingly incorporate precision medicine principles, powered by the expansion of targeted drug options. He posits that as more data emerge, clinicians will be able to identify disease subsets and tailor interventions based on differential responses to therapies targeting specific pathogenic mechanisms.

While the classic stepwise approach (escalating from antihistamines to targeted therapies) will likely persist for reasons of efficiency and stewardship, the growing variety of advanced treatments will permit greater flexibility and customization, particularly for patients with unique clinical characteristics or comorbidities. Hawkes stresses that this trend is visible in conditions such as psoriasis, eczema, and hidradenitis suppurativa, as well as CSU.

He also highlights the importance of ongoing research into new drug classes, such as C-kit inhibitors, and the real-world adaptation of step-up and step-down approaches based on patient response and tolerability. Hawkes concludes that the future of CSU therapy lies in weaving evidence-based pathways with the nuanced understanding of patient subtypes and evolving mechanistic insights.

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Jason Hawkes, MD, MS, envisions the future of CSU management, highlighting the integration of precision medicine and targeted therapies to individualize care.




Identifying the Optimal CSU Patient Population for Remibrutinib

Jason Hawkes, MD, MS, a board-certified dermatologist and associate professor of Dermatology at the University of California Davis, notes that, unlike omalizumab, for which IgE levels may predict response, remibrutinib and dupilumab demonstrate efficacy irrespective of baseline IgE concentrations. This widens their applicability to both IgE-dependent and IgE-independent CSU populations, as well as those who have failed other therapies.

Despite these advances, Hawkes emphasizes the current lack of robust biomarkers or clinical predictors for individual response to BTK inhibitors and other novel agents in CSU. He stresses the ongoing need for further research to address this knowledge gap and optimize precision medicine approaches within the field.

Until more definitive markers are established, Hawkes encourages clinicians to focus primarily on reducing patient disease burden and improving quality of life, using available therapies judiciously and empirically while remaining alert for future evidence that could refine patient selection.

Jason Hawkes, MD, MS, discusses emerging biomarkers and clinical characteristics that may help identify patients most likely to benefit from remibrutinib in CSU.



Role of Remibrutinib in Current Guideline-Based Care for CSU

Jason Hawkes, MD, MS, a board-certified dermatologist and associate professor of Dermatology at the University of California Davis, clarifies that recent and forthcoming CSU management guidelines now position remibrutinib alongside omalizumab and dupilumab as a reasonable next step for patients who do not respond to antihistamines, both at standard and escalated doses. This represents a move away from the historical paradigm in which omalizumab was the sole third-line agent.

He outlines that, while omalizumab has the most long-term safety and efficacy data, practical considerations—such as ease of use, patient preference, and specialist comfort—are shaping real-world utilization patterns. Dermatologists, in particular, may prefer newer targeted options that lack black box warnings and offer more flexibility compared to traditional immunosuppressants like methotrexate or cyclosporine.

The evolving guidelines thus provide clinicians with additional advanced therapy options and empower them to tailor treatments with an evidence-based but pragmatic approach, ultimately enhancing care and outcomes for patients with CSU.

Jason Hawkes, MD, MS, explains how updated treatment guidelines are incorporating remibrutinib as a key option for CSU after antihistamine failure.



Benefits of Oral BTKi Administration in CSU

Jason Hawkes, MD, MS, a board-certified dermatologist and associate professor of Dermatology at the University of California Davis outlines the mechanistic rationale for using oral BTK inhibitors, such as remibrutinib, in CSU. He notes remibrutinib’s selective inhibition of Bruton tyrosine kinase—central to mast cell activation—and its rapid, robust effect on both superficial and deep urticarial manifestations, including angioedema.

According to Hawkes, remibrutinib offers particular benefit to patients who have failed, are intolerant of, or are not candidates for antihistamines, omalizumab, or dupilumab. Its oral route confers convenience, making it well-suited for individuals already managing multiple medications or those averse to injectable therapies. Clinical improvements appear to be independent of baseline IgE levels, broadening its applicability across varied patient phenotypes.

Hawkes advises that the choice of remibrutinib can also be informed by unique patient characteristics, such as previous intolerance to other therapies, lifestyle considerations, and preference for oral versus injectable medications. He emphasizes that its rapid onset, broad efficacy, and safety profile support its integration into the therapeutic armamentarium for CSU.

Jason Hawkes, MD, MS details the clinical advantages and patient populations best suited for oral BTK inhibitor therapy, such as remibrutinib, in CSU.


Jason Hawkes, MD, MS

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