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xanomeline

Phase 3

Schizophrenia | Small molecule | Psychiatry |Bristol-Myers Squibb Company|Last Updated: Jul 31, 2026

Target and mechanism

ModalitySmall molecule

Also known as Xanomeline and trospium chloride (KarXT), Xanomeline and trospium chloride

Success Probability

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Market & Valuation

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Trial Design

RandomizedDouble-BlindACTIVE_CONTROLLEDDMC
Total Trials10
Total Enrollment2,838

FDA Designations

No designations recorded

Clinical trial landscape

xanomeline · 10 trials · 2 indications

Phase 3 8Phase 2 1Phase 1 1
NCT07686263Relapse Prevention Trial Evaluating KarXT Treatment in SchizophreniaSchizophrenia
NOT YET_RECRUITING472 Analytics
NCT05919823A Study to Assess the Efficacy and Safety of KarXT in Acutely Psychotic Hospitalized Chinese Adult Subjects With DSM-5 SchizophreniaSchizophrenia
COMPLETED202 Analytics
NCT05304767An Extension Study to Assess Long-Term Safety and Tolerability of Adjunctive KarXT in Subjects With Inadequately Controlled Symptoms of SchizophreniaSchizophrenia
COMPLETED290 Analytics
NCT05145413A Study to Assess Efficacy and Safety of Adjunctive KarXT in Subjects With Inadequately Controlled Symptoms of SchizophreniaSchizophrenia
COMPLETED396 Analytics
NCT04820309An Open-label Study to Assess the Long-term Safety, Tolerability, and Efficacy of KarXT in Adult Patients With Schizophrenia (EMERGENT-5)Schizophrenia
COMPLETED566 Analytics
NCT04738123A Study to Assess Efficacy and Safety of KarXT in Acutely Psychotic Hospitalized Adult Patients With Schizophrenia (EMERGENT-3)Schizophrenia
COMPLETED256 Analytics
NCT04659174An Extension Study to Assess Long-term Safety, Tolerability, and Efficacy of KarXT in Adult Patients With Schizophrenia (EMERGENT-4)Schizophrenia
COMPLETED152 Analytics
NCT04659161A Study to Assess Efficacy and Safety of KarXT in Acutely Psychotic Hospitalized Adult Patients With Schizophrenia (EMERGENT-2)Schizophrenia
COMPLETED252 Analytics
PHASE3NOT YET_RECRUITING
Relapse Prevention Trial Evaluating KarXT Treatment in Schizophrenia
SchizophreniaUnlock trial analytics
PHASE3COMPLETED
A Study to Assess the Efficacy and Safety of KarXT in Acutely Psychotic Hospitalized Chinese Adult Subjects With DSM-5 Schizophrenia
SchizophreniaUnlock trial analytics
PHASE3COMPLETED
An Extension Study to Assess Long-Term Safety and Tolerability of Adjunctive KarXT in Subjects With Inadequately Controlled Symptoms of Schizophrenia
SchizophreniaUnlock trial analytics
PHASE3COMPLETED
A Study to Assess Efficacy and Safety of Adjunctive KarXT in Subjects With Inadequately Controlled Symptoms of Schizophrenia
SchizophreniaUnlock trial analytics
PHASE3COMPLETED
An Open-label Study to Assess the Long-term Safety, Tolerability, and Efficacy of KarXT in Adult Patients With Schizophrenia (EMERGENT-5)
SchizophreniaUnlock trial analytics
PHASE3COMPLETED
A Study to Assess Efficacy and Safety of KarXT in Acutely Psychotic Hospitalized Adult Patients With Schizophrenia (EMERGENT-3)
SchizophreniaUnlock trial analytics
PHASE3COMPLETED
An Extension Study to Assess Long-term Safety, Tolerability, and Efficacy of KarXT in Adult Patients With Schizophrenia (EMERGENT-4)
SchizophreniaUnlock trial analytics
PHASE3COMPLETED
A Study to Assess Efficacy and Safety of KarXT in Acutely Psychotic Hospitalized Adult Patients With Schizophrenia (EMERGENT-2)
SchizophreniaUnlock trial analytics

Study Endpoints

Primary Endpoints

Time From Randomization to the First Relapse Event
Up to approximately Week 43
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Scores at Week 5 of the Double-Blind Period
At Baseline and at Week 5 of the Double-Blind Period

PANSS Total Score is a clinical tool used to measure the severity of symptoms in individuals with schizophrenia. It includes 30 items divided into three subscales: Positive Symptoms (e.g., hallucinations, delusions) Negative Symptoms (e.g., social withdrawal, lack of motivation) General Psychopathology (e.g., anxiety, depression) Each item is rated from 1 (absent) to 7 (extreme), resulting in a total score range from 30 to 210. Higher PANSS Total Scores indicate more severe symptoms and worse clinical outcomes. Baseline is defined as last non-missing assessment prior to the first dose of study drug.

Incidence of treatment-emergent adverse events (TEAEs)
From initial dose to safety follow-up visit (54 weeks) or early termination
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at Week 6
Baseline to Week 6

PANSS Total Score is a clinician administered measure of schizophrenia symptom severity used widely in antipsychotic research. It includes 30 items across 3 subscales: * Positive Symptoms (7 items) assessing excesses or distortions such as hallucinations, delusions, or grandiosity * Negative Symptoms (7 items) assessing diminished function such as social withdrawal or reduced motivation and * General Psychopathology (16 items) capturing broader symptoms like anxiety, depression, guilt, or cognitive impairment Each item is scored from 1 (absent) to 7 (extreme), producing a PANSS Total Score ranging from 30 to 210, with higher scores indicating more severe symptoms. Baseline is defined as the last non missing PANSS Total Score before first dose. This endpoint evaluates change from Baseline to Week 6, with negative values indicating improvement.

Number of Participants With Treatment Emergent Adverse Events (TEAEs)
From time of consent to end of study (approximately 400 days)

TEAEs are defined as events with an onset date on or after the first dose of KarXT. An Adverse Event is any symptom, physical sign, syndrome, or disease that either emerges during the study or, if present at baseline, worsens during the study, regardless of the suspected cause of the event using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), version 5.0.

Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at Week 5
From baseline up to Week 5

The Positive and Negative Syndrome Scale (PANSS) is a medical scale used for measuring symptom severity of participants with schizophrenia and is widely used in the study of antipsychotic therapy. The PANSS rating form contains 7 positive symptom scales, 7 negative system scales, and 16 general psychopathology symptom scales. Participants are rated from 1 to 7 on each symptom scale. The positive symptoms in schizophrenia are the excess or distortion of normal function such as hallucinations, delusions, grandiosity, and hostility, and the negative symptoms in schizophrenia are the diminution or loss of normal functions. PANSS total score is the sum of all 30 items with a minimum score of 30 and a maximum score of 210. Higher scores indicate more severe symptoms. The PANSS Total Score is then the sum of the positive, negative, and general psychopathology symptom scores. Baseline is defined as the PANSS score at screening.

Number of Participants With Treatment-Emergent Adverse Events (TEAEs)
From first dose to end of study (Up to approximately 53 weeks)

TEAEs are defined as events with an onset date on or after the first dose of KarXT. An Adverse Event is any symptom, physical sign, syndrome, or disease that either emerges during the study or, if present at baseline, worsens during the study, regardless of the suspected cause of the event using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), version 5.0.

Mean weekly maximum composite Visual Analogue Scale (VAS) score (nausea, diarrhea, sweating, salivation and vomiting combined) comparing xanomeline + placebo to xanomeline + trospium
7 days

Secondary Endpoints

Time to Discontinuation During Double-blind Treatment Period
Approximately From Week 18 to 43
Number of Participants With Treatment Emergent Adverse Events (TEAEs)
Up to approximately Week 45
Number of Participants With Adverse Events of Special Interest (AESIs)
Up to approximately Week 45
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Study Design & Arms

AllocationRANDOMIZED
MaskingQUADRUPLE
ModelPARALLEL
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
KarXTEXPERIMENTAL -
PlaceboPLACEBO_COMPARATOR -
Drug: KarXTEXPERIMENTAL -
Xanomeline plus placeboACTIVE_COMPARATORDrug: Xanomeline tartrate 75 mg TID, for 225 mg total daily dose Placebo, TID
Xanomeline plus trospiumEXPERIMENTALDrug: Xanomeline tartrate 75 mg TID, for 225 mg total daily dose Drug: Trospium chloride 20 mg BID, for a 40 mg total daily dose

Interventions

NameTypeDescription
Xanomeline/Trospium ChlorideDRUGSpecified dose on specified days
PlaceboDRUGSpecified dose on specified days
Xanomeline and Trospium Chloride CapsulesDRUGOral xanomeline 50 mg/trospium 20 mg BID on days 1-2 followed by xanomeline 100 mg/trospium 20 mg BID on days 3-7. The dose is increased to xanomeline 125 mg/trospium 30 mg BID on days 8-35 unless the subject is experiencing adverse events from the xanomeline 100 mg/ trospium 20 mg dose. Subjects who were increased to xanomeline 125 mg/trospium 30 mg will have the option to return to xanomeline 100 mg/ trospium 20 mg depending on clinical response and tolerability.
Placebo CapsulesDRUGPlacebo Capsules
xanomeline tartrateDRUGxanomeline tartrate, 75 mg capsule, TID
Trospium chlorideDRUGtrospium chloride, over encapsulated 20 mg tablet, BID
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Eligibility Criteria

Age Range18 Years to 65 Years
SexALL
Healthy VolunteersNo
Study Sites61

Inclusion Criteria * Participant must have a primary diagnosis of schizophrenia for at least 1 year established by a comprehensive psychiatric evaluation based on the DSM-5-TR (American Psychiatric Association 2022) criteria and confirmed by MINI for Psychotic Disorder Studies version 7.0.2 at scre...

Countries:United StatesArgentinaBulgariaCzechiaDenmarkPolandRomaniaSpainUnited KingdomChinaJapanSerbiaIndiaPuerto RicoUkraine
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Recent Changes (Last 90 Days)

MEDIUMAug 31, 2026NCT05304767TRIAL_REMOVED: changed
MEDIUMAug 31, 2026NCT05304767TRIAL_REMOVED: changed
MEDIUMAug 31, 2026NCT05304767TRIAL_REMOVED: changed
MEDIUMAug 31, 2026NCT05304767TRIAL_REMOVED: changed
HIGHJul 31, 2026NCT05304767Status: RECRUITING → COMPLETED
HIGHJul 31, 2026NCT05304767Status: RECRUITING → COMPLETED
LOWJul 7, 2026NCT07686263NEW_TRIAL: changed
LOWJul 7, 2026NCT07686263NEW_TRIAL: changed

Frequently asked questions about xanomeline

What is Xanomeline and trospium chloride used for?

Xanomeline and trospium chloride, also known as KarXT, is an investigational small molecule being studied for schizophrenia, Alzheimer's disease, and mania associated with bipolar I disorder. It is also used in clinical trials involving healthy volunteers to evaluate drug interactions and formulations.

What does Xanomeline and trospium chloride target?

Xanomeline and trospium chloride is a combination of xanomeline, a muscarinic acetylcholine receptor agonist, and trospium chloride, a muscarinic receptor antagonist. The combination is designed to target muscarinic receptors in the brain while limiting peripheral side effects.

Who makes Xanomeline and trospium chloride?

Xanomeline and trospium chloride is being developed by Bristol-Myers Squibb Company, traded on the New York Stock Exchange under the ticker BMY. The company is conducting clinical trials across multiple indications including schizophrenia, Alzheimer's disease, and bipolar disorder.

What phase is Xanomeline and trospium chloride in?

Xanomeline and trospium chloride is in Phase 1 clinical development for healthy volunteer studies and Phase 3 clinical development for Alzheimer's disease and mania associated with bipolar I disorder. It is investigational and not yet approved by the FDA.

What clinical trials is Xanomeline and trospium chloride in?

Xanomeline and trospium chloride is being studied in several trials including NCT06729970, a Phase 1 drug interaction study in healthy volunteers; NCT07011732, a Phase 3 study for agitation in Alzheimer's disease; NCT07063342, a Phase 1 formulation study; and NCT07140913, a Phase 3 study for mania in bipolar I disorder.

Is Xanomeline and trospium chloride the same as KarXT?

Yes, Xanomeline and trospium chloride is also known as KarXT, as well as xanomeline/trospium and xanomeline/trospium chloride. These names refer to the same investigational drug combination being developed by Bristol-Myers Squibb.