Addressing Hesitancy With Oral vs Injectable Options in CSU

Jason Hawkes, MD, MS, a board-certified dermatologist and associate professor of Dermatology at the University of California Davis, notes that patient hesitancy toward injectables is more often rooted in concerns about systemic effects and invasiveness than in the act of injection itself. He draws parallels with hesitancy observed in patients with diabetes initiating insulin therapy, emphasizing that reservations about injectables are not uncommon but are typically surmountable through education.

He advocates a transparent approach to patient education, explaining that biologics like remibrutinib and dupilumab are highly targeted, potentially less likely to cause broad off-target effects compared to some oral small molecules. Hawkes conveys these points using analogies, likening biologics to "snipers" in their specificity for disease targets, which can help patients understand and trust the rationale for therapy selection.

Ultimately, Hawkes positions the physician’s role not as persuading patients toward a specific modality, but as equipping them with the information necessary for shared, informed decision-making. By demystifying the mechanisms of action and underscoring the targeted nature of available therapies, clinicians can facilitate patient confidence and buy-in regarding their CSU management plan.