A New Treatment for Chronic Hives: Remibrutinib
Welcome to the latest Allergy, Asthma & Immunology Innovations podcast. This episode is part of The Itch Review, where we highlight important research in allergy and immunology. In this episode, we look at the REMIX trial. This study asked: can a new pill called remibrutinib help people whose long-term hives aren’t getting better with antihistamines?
Our hosts, Payel Gupta, MD, and Kortney Kwong Hing, are joined by Michael Blaiss, MD, to review the article, “Remibrutinib in Chronic Spontaneous Urticaria,” published in the March 2025 issue of The New England Journal of Medicine.
What is chronic spontaneous urticaria (CSU)? It involves itchy hives that keep coming back for more than 6 weeks with no clear cause. For many people with CSU, antihistamines may not help enough. Remibrutinib (brand name Rhapsido®) is a new type of medicine called a BTK inhibitor that works differently. Instead of blocking histamine after it’s released, it stops the release of itch-causing chemicals in the first place.
The U.S. Food and Drug Administration (FDA) approved remibrutinib in September 2025.
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This podcast is for informational purposes only and does not substitute professional medical advice. Any mention of brands is also informational and not an endorsement. Always consult with your healthcare provider for any medical questions or concerns.
Thank you to Novartis for sponsoring this podcast episode.
Key Takeaways about the REMIX Trial
This study looked at whether remibrutinib could help adults with chronic hives that don’t get better with antihistamines. Here’s what researchers found:
- Remibrutinib works in a new way. It stops mast cells from releasing itching chemicals like histamine, instead of blocking them after they’re already out.
- Researchers ran two identical studies. Running the same study twice with different people helped prove the results were real and not just a one-time finding.
- About half of patients got their hives under control. Around 50% of people on remibrutinib had mild hives or itching after 12 weeks.
- About 1 in 3 became completely clear. Around 30% had no hives and no itch at all.
- It worked fast. Many people saw improvement within the first 1 to 2 weeks.
Timestamps for the REMIX Trial Podcast Episode
01:25 — What is chronic spontaneous urticaria
04:40 — BTK inhibitors used in different diseases
05:25 — Paper objective
06:10 — Study design
09:20 — Primary outcome: change in UAS7 score
15:53 — Study participants
17:58 — Results of the study
24:27 — Safety profile
27:01 — Petechiae and bleeding events
35:06 — Study limitations
37:36 — Doctor takeaways
