Bruton’s Tyrosine Kinase Inhibitors in Chronic Spontaneous Urticaria: Unraveling Mechanisms, Clinical Efficacy, and Future Perspectives

Thu, 30 Apr 2026 00:00:00 +0000

Chronic spontaneous urticaria (CSU) is an inflammatory process that is mediated by mast cells, and that is characterized by the presence of recurrent wheals or angioedema or both over a period of more than six weeks. Antihistamines and biologic agents, including Omalizumab, have been available, but still a certain number of patients turn out to be resistant, and that is why it is necessary to find new targeted therapies. A promising target is Bruton tyrosine kinase (BTK), a central mediator of Fc5 receptor (Fc 5) signaling in mast cells and basophils. This narrative review included a collection of evidence about BTK inhibitors in CSU. PubMed and Google Scholar were searched in a structured manner covering up to February 2026. Randomized controlled trials, early-phase clinical trials, observational studies, and mechanistic studies evaluating the BTK inhibitors in CSU were all included in the search. Compilation of the results was done in a descriptive manner lacking a risk-of-bias evaluation. Preliminary clinical trials have demonstrated that specific BTK inhibitors, including remibrutinib and rilzabrutinib, cause quick decreases in the urticaria activity rating, enhance the symptoms and have favorable safety profiles in the short-term. BTK inhibition has been confirmed as a useful treatment in mechanistic studies to inhibit mast cell and basophil cell activation, thus preventing IgE-mediated and autoantibody-driven pathways that cause CSU. Initial findings suggest that there is a significant improvement in the patients who are antihistamine-resistant, but the long-term safety and maintenance of the response rates remain to be explored. BTK inhibitors are an encouraging new therapy in the treatment of CSU. Phase III trials and real-world investigations in the future will assist to establish their long-term effectiveness, safety, and place in the present treatment guidelines. This Review sets out to incorporate the current literature on the use of Bruton tyrosine kinase inhibitors in chronic spontaneous urticarcia.

Journal of Women Medical and Dental College

Bruton’s Tyrosine Kinase Inhibitors in Chronic Spontaneous Urticaria: Unraveling Mechanisms, Clinical Efficacy, and Future Perspectives