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.