Ep. 147: The REMIX Trial: Remibrutinib for Chronic Hives
Part of the series: The Itch Review
This podcast was made in partnership with Allergy & Asthma Network. We thank AstraZeneca forsponsoring this episode. While they support the show, all opinions are our own, and sponsorship doesn’t influence our content or editorial decisions. Any mention of brands is for informational purposes and not an endorsement.
If you have chronic hives and antihistamines aren't helping, there's a new treatment option to know about. In this episode of The Itch Review, we spotlight "Remibrutinib in Chronic Spontaneous Urticaria" published in The New England Journal of Medicine, March 2025.
This article looks at the REMIX trials, which tested whether remibrutinib, a BTK inhibitor, can help adults whose chronic spontaneous urticaria (CSU) is not controlled by antihistamines alone. Remibrutinib works differently from antihistamines. Instead of blocking histamine after it's released, it stops mast cells from releasing those itch-causing chemicals in the first place.
The FDA approved remibrutinib in September 2025.
What we cover in our episode about the REMIX trial
Understanding CSU: Chronic spontaneous urticaria causes itchy hives and swelling for more than 6 weeks with no clear trigger, and antihistamines don't work for everyone.
How remibrutinib works: This BTK inhibitor stops mast cells from releasing chemicals like histamine, rather than blocking histamine after it's already released.
Why do two identical trials: Running the same study twice (REMIX-1 and REMIX-2) with different patients helps prove the results are real, not a fluke.
Key results: About half of patients reached well-controlled disease and about 1 in 3 became completely clear of hives and itch.
Safety and side effects: Petechiae (tiny dots of bleeding under the skin) were the main thing to watch for, but most cases were mild and went away on their own.
More The Itch Review episodes on BTK inhibitors and hives
More hive resources
The Itch Review, hosted by Dr. Gupta, Kortney, and Dr. Blaiss, explores allergy and immunology studies, breaking down complex research in conversations accessible to clinicians, patients, and caregivers. Each episode provides key insights from journal articles and includes a one-page infographic in the show notes for easy reference.
Timestamps
Our episode discussesthe REMIX trials for a new hives medication
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
24:27 Safety profile
27:01 Petechiae and bleeding events
35:06 Study limitations
37:36 Doctor takeaways
