Remibrutinib: Insights Into Its Mechanism of Action and Use for Dermatologic Conditions

OBJECTIVE: Chronic spontaneous urticaria (CSU) is a chronic, debilitating condition characterized by recurrent wheals and/or angioedema. Several cytokines have been linked to CSU, including Bruton tyrosine kinase (BTK), providing the rationale for emerging targeted therapies. Remibrutinib is an oral, highly selective BTK inhibitor that is in clinical development for CSU as well as several other dermatologic diseases. METHODS: A comprehensive literature search was completed using the keywords "chronic spontaneous urticaria," "pathogenesis," "Bruton tyrosine kinase," "remibrutinib," and "mechanism of action". The authors reviewed all studies and included those that addressed the topic of the review. RESULTS: Remibrutinib has completed phase 3 trials for the treatment of CSU. Remibrutinib-treated patients experienced a significantly greater decrease in 7-day Urticaria Activity Score at week 12 compared to placebo in REMIX-1 (-20.0 remibrutinib vs -13.8 placebo, P<0.001) and REMIX-2 (-19.4 remibrutinib vs -11.7 placebo, P<0.001). Clinically meaningful effects were seen after one week. The rate of adverse effects was similar between remibrutinib and placebo groups. Remibrutinib is also being evaluated in clinical trials for hidradenitis suppurativa, with a phase 2 clinical trial reporting 72.7% of remibrutinib-treated patients with 25 mg twice daily achieved simplified HS clinical response score vs 34.7% in the placebo group. LIMITATIONS: This is a review article and is limited by the information available in the published literature. In addition, comparison between studies is limited as varying methodologies were used. CONCLUSION: BTK inhibitors are promising therapeutic candidates given their central role in multiple inflammatory pathways and the pathogenesis of diverse immunologic disorders. Remibrutinib has demonstrated clinical efficacy for the treatment of CSU with an acceptable safety profile.