Anticipated Role of New Therapies in CSU Guidelines, Management

With the imminent update to chronic spontaneous urticaria (CSU) management guidelines, multiple newly approved therapies are anticipated to be positioned alongside existing options for patients with antihistamine-refractory disease. Shyam Joshi, MD, assistant professor of medicine in the Section of Allergy and Clinical Immunology at Oregon Health & Science University (OHSU) School of Medicine, discusses how previous guidelines, could give way to an evidence-based framework embraces shared decision-making based on patient preference, presentation, and comorbidities. Recent meta-analyses and clinical trial data indicate that both omalizumab and remibrutinib demonstrate the most favorable balance of efficacy and safety among the available agents.

The introduction of these new agents is expected to significantly enhance individualized care. With options spanning multiple mechanisms and modes of administration, clinicians will be able to tailor therapy based on patient-specific factors and clinical context. Remibrutinib, in particular, stands out for its oral route, rapid onset of action, and robust efficacy, supporting its use as either an early post-antihistamine option or as an alternative for patients for whom injectable biologics are contraindicated or unacceptable.

Joshi anticipates that the evolving treatment landscape will reshape CSU management over the next several years, mirroring advances observed in other atopic and inflammatory conditions. The ability to offer multiple safe and effective therapies will better address the diverse needs and preferences of CSU patients, foster more productive patient-provider discussions, and improve overall disease outcomes as future guidelines are adopted.