A Study to Evaluate Efficacy of Remibrutinib Compared to Dupilumab at Early Timepoints in Adults With Chronic Spontaneous Urticaria Inadequately Controlled by Second Generation H1-antihistamines

Last updated: June 4, 2026
Sponsor: Novartis Pharmaceuticals
Overall Status: Active - Recruiting

Phase

3

Condition

Hives (Urticaria)

Urticaria

Treatment

Dupilumab

Remibrutinib matching placebo

Placebo solution for injection

Clinical Study ID

NCT06868212
CLOU064AUS02
  • Ages > 18
  • All Genders

Study Summary

This is a US, multi-center, randomized, double-blind, double-dummy, Phase 3b study to evaluate efficacy of remibrutinib (25 mg twice daily [b.i.d.] by mouth [p.o.]) compared to dupilumab (600 mg loading dose administered subcutaneously (s.c.) followed by 300 mg every 2 weeks s.c.) at early timepoints (4 weeks and earlier), when administered as an add-on treatment to second generation H1-antihistamines (sgH1-AH) (standard label dose as background therapy) in adult US participants with moderate to severe chronic spontaneous urticaria (CSU) inadequately controlled by sgH1-AHs.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Adults ≥ 18 years of age at the time of signing the informed consent

  • CSU duration for ≥ 6 months prior to screening (defined as the onset of CSUdetermined by the Investigator based on all available supporting documentation)

  • Diagnosis of CSU inadequately controlled by sgH1-AH at the time of randomization,defined as:

  • The presence of itch and hives for ≥ 6 consecutive weeks prior to screening despitethe use of sgH1-AH during the 7 days prior to randomization (Day 1):

  • UAS7 score (range, 0-42) ≥ 16, and

  • ISS7 score (range, 0-21) ≥ 6, and

  • HSS7 score (range, 0-21) ≥ 6

  • Documentation of hives within 3 months before randomization (either at screeningand/or at randomization); or documented in the participants medical history

  • Willing and able to complete an Urticaria Patient Daily Diary (UPDD) for theduration of the study and adhere to the study protocol

  • Participants must not have had more than one missing UPDD entry (either morning orevening) in the 7 days prior to randomization (Day 1)

Exclusion

Exclusion Criteria:

  • Previous use of remibrutinib or other bruton's tyrosine kinase (BTK) inhibitors

  • Previous use of dupilumab

  • Evidence of clinically significant cardiovascular (such as but not limited tomyocardial infarction, unstable ischemic heart disease, NYHA Class III/IV leftventricular failure, arrhythmia and uncontrolled hypertension within 12 months priorto Visit 1), neurological, psychiatric, pulmonary, renal, hepatic (past history orcurrent), endocrine or metabolic disorder, or immunodeficiency that, in theinvestigator's opinion, would compromise the safety of the participant, interferewith the interpretation of the study results or otherwise preclude participation orprotocol adherence of the participant.

  • Evidence of hematological disorders (including coagulation disorders or significantbleeding risk)

  • History or evidence of gastrointestinal disease (including gastrointestinalbleeding, e.g., in association with use of nonsteroidal anti-inflammatory drugs (NSAID), that was clinically relevant (e.g., where intervention was indicated orrequiring hospitalization or blood transfusion)

  • Requirement for anti-platelet medication, except for acetylsalicylic acid up to 100mg/d or clopidogrel up to 75 mg/d. The use of dual anti-platelet therapy (e.g.,acetylsalicylic acid + clopidogrel) is prohibited.

  • Requirement for anticoagulant medication (for example, warfarin or Novel OralAnti-Coagulants [NOAC])

  • History or current hepatic disease including but not limited to acute or chronichepatitis, cirrhosis or hepatic failure or hepatic parameters at screening:Aspartate Aminotransferase (AST)/ Alanine Aminotransferase (ALT) levels more than 1.5x ULN or International Normalized Ratio (INR) > 1.5 at screening

Study Design

Total Participants: 400
Treatment Group(s): 4
Primary Treatment: Dupilumab
Phase: 3
Study Start date:
July 11, 2025
Estimated Completion Date:
May 17, 2027

Study Description

This study consists of a screening period (up to 4 weeks), a core treatment period (12 weeks double-blind, double-dummy), an optional open-label extension [OLE] period, and safety follow-up period.

Screening period: participants will have a screening period of a minimum of 7 days up to a maximum of 28 days to establish eligibility for the study. Participants meeting all the inclusion criteria and none of the exclusion criteria will be eligible to participate in the study.

Core treatment period (double-blind, double-dummy): approximately, 400 participants diagnosed with CSU inadequately controlled by sgH1-AH will be randomized in this study. Participants will be stratified based on prior exposure to anti-IgE biologics.

Eligible participants will be randomized in a 1:1 ratio to receive remibrutinib and placebo solution for injection or dupilumab and remibrutinib matching placebo, both as an add-on treatment to once daily standard label dose of sgH1-AH background therapy, until the Week 12 visit.

Additionally, all participants will be on a stable, standard label dose of a sgH1-AH ("background therapy") throughout the entire core treatment period (starting a minimum of 7 days prior to randomization until the end of Week 12). To treat unbearable symptoms of CSU, participants will be allowed to add more of the same sgH1-AH on an as-needed basis ("rescue therapy"). The total maximum daily dose of sgH1-AH (background plus rescue) should not exceed 4 tablets/day (4-fold the standard label dose).

Optional open-label extension [OLE] period: At the end of the 12-week double-blind treatment period, and in case remibrutinib is not commercially available, participants from both arms will be given the choice to roll over into an optional OLE safety period and receive remibrutinib (25 mg b.i.d. p.o.) for 12 weeks (up to Week 24).

Safety follow-up period:

  • For participants who do not enter the OLE period: there will be a safety follow-up for 12 weeks with safety follow-up phone calls at Week 16 and Week 24 (Week 24 will be end of study).

  • For participants who enter the OLE period: there will be 2 options at the end of Week 24:

  • If remibrutinib is commercially available: participants will discontinue study treatment, perform their EOT visit and receive a safety follow-up phone call 4 weeks after the last dose of remibrutinib (this will be the EOS).

  • If remibrutinib is not commercially available, participants may continue on remibrutinib 25 mg b.i.d. until its commercial availability and return for site visits for safety follow up and treatment dispensation every 3 months. When remibrutinib becomes commercially available, the participant will be contacted for a site visit to complete the EOT visit and will receive a safety follow-up phone call 4 weeks after the last dose of remibrutinib (this will be the EOS).

Connect with a study center

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