Recently, Novartis has made significant strides in the chronic spontaneous urticaria (CSU) market, announcing a priority review application for its BTK inhibitor Remibrutinib and a $830 million deal to acquire Kyorin's clinical-stage MRGPRX2 antagonist.
The announcement highlights Novartis' commitment to maintaining its leadership position in the CSU treatment landscape, which is marked by a prevalence rate of approximately 0.05% to 3%, with CSU accounting for about 68% of chronic urticaria cases. The condition primarily manifests as hives and itching, and can lead to deeper systemic issues, increasing the risk of autoimmune diseases and cancers. First-line treatment typically involves H1 antihistamines, but nearly half of patients struggle to achieve adequate control, necessitating additional therapies.
The global CSU market is projected to grow from $779.28 million in 2024 to $1.54141 billion by 2032, with a compound annual growth rate (CAGR) of 8.90% from 2025 to 2032. As awareness and treatment demands increase, this market is poised for continued growth.
As a market leader, Novartis has long relied on its collaboration with Roche to dominate the CSU field with Xolair (omalizumab), an anti-IgE drug that has generated over $4.3 billion in sales in 2024, despite emerging competition. However, with the expiration of Xolair's compound patent and an impending expiry of its formulation patent in November 2025, Novartis faces pressure from competitors like Sanofi/Regenron's Dupixent (dupilumab), which has recently gained approval for CSU in Japan and is challenging Xolair's dominance.
In light of these developments, Novartis has shifted its focus to exploring next-generation therapies, particularly BTK inhibitors. Bruton’s tyrosine kinase (BTK) plays a crucial role in CSU's pathogenesis, and inhibiting BTK can prevent mast cell activation and the production of autoantibodies, addressing two primary pathological mechanisms of CSU.
Last year, Novartis reported positive results from two pivotal Phase III trials of Remibrutinib, demonstrating significant symptom improvement over 52 weeks. The recent submission of its New Drug Application (NDA) positions Remibrutinib as a potential successor to Xolair, aiming to solidify Novartis' standing in the CSU market.
In addition to Remibrutinib, Novartis is strategically acquiring promising candidates like KRP-M223, an MRGPRX2 antagonist, which is anticipated to enhance its portfolio in this therapeutic area. MRGPRX2, a G protein-coupled receptor expressed predominantly on mast cells, is activated during allergic responses, leading to the release of mediators such as histamine. Although KRP-M223 is still in preclinical stages, its unique mechanism holds the potential for significant advancements in treating CSU and related allergic conditions.
In the domestic market, several promising therapies targeting CSU are advancing through clinical trials. Notably, Tianchen Biotech's LP-003, a next-generation anti-IgE antibody, recently reported mid-stage Phase II clinical data that surpassed Xolair's efficacy. With a dosing regimen of every 8 weeks, LP-003 could significantly improve patient compliance compared to Xolair's more frequent administration.
Another contender is Jimin Xinke's JYB1904, a long-acting anti-IgE antibody that boasts a half-life more than twice that of Xolair, reducing injection frequency and potentially enhancing patient adherence to treatment.
As Novartis strengthens its position in the CSU market with innovative therapies and strategic acquisitions, the competitive landscape continues to evolve. The battle for dominance in this lucrative market is intensifying, with Novartis poised to defend its title against emerging threats while exploring new growth avenues.
