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.