A Daily Pill for Chronic Hives Just Got a Major Expansion

If light pressure, a scratch or even the strap of your bag leaves raised, itchy welts on your skin, there’s new relief on the horizon. Today, Novartis announced that the FDA has approved Rhapsido (remibrutinib) as the first treatment for symptomatic dermographism (SD), a form of chronic hives, in adults whose symptoms aren’t adequately controlled with H1 antihistamines.

The news comes just over a year after the twice-daily pill earned its first approval, for chronic spontaneous urticaria (CSU), in fall 2025. Together, CSU and SD account for more than 90 percent of adults living with chronic hives, according to Novartis, and Rhapsido is now the only treatment cleared for both when antihistamines alone fall short.

What’s the difference between the two?

With CSU, hives and itching flare up without any clear outside cause. SD, on the other hand, is a type of chronic inducible urticaria, meaning something specific sets it off. For SD, that trigger is friction or pressure on the skin, so people with SD can develop welts from everyday actions like scratching an itch or wearing snug clothing.

How it works

Rhapsido is a Bruton’s tyrosine kinase (BTK) inhibitor, a newer class of medication that targets the process behind hives at the source. It works by blocking BTK’s role in mast cell degranulation, the step that releases histamine and triggers welts and itching, while also targeting the immune cells that produce the autoantibodies tied to the condition.

The results

The approval was based on data from Novartis’ late-stage RemIND trial, which studied patients who were still experiencing symptoms despite taking second-generation antihistamines. Among those with SD, 29.3 percent of patients on Rhapsido saw a complete response on a clinical measure of symptom severity, compared with 14 percent on placebo.

The company says the drug showed a consistent safety profile across both SD and CSU for up to 24 weeks. Victor Bultó, Novartis U.S. president, said the approval means more people may be able to “find relief from persistent itch” and spend less time focused on their symptoms.

What’s next

Novartis is also studying Rhapsido in other types of inducible hives, including cold urticaria and cholinergic urticaria (hives triggered by heat or sweating). The drug was approved in Europe for CSU earlier this year.

If you’re dealing with hives that keep coming back, talk to your dermatologist or allergist about whether this new option could be right for you.