A Study to Assess Efficacy and Safety of KarXT in Acutely Psychotic Hospitalized Adult Patients With Schizophrenia (EMERGENT-3)

A Phase 3, Randomized, Double-blind, Parallel-group, Placebo-controlled, Multicenter Study to Evaluate the Efficacy and Safety of KarXT in Acutely Psychotic Hospitalized Adults With DSM-5 Schizophrenia

Status

Completed

Phases

Phase 3

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT04738123

Enrollment

256

Registered

2021-02-04

Start date

2021-04-06

Completion date

2022-12-07

Last updated

2024-12-09

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Schizophrenia, Schizophrenia; Psychosis

Brief summary

This is a Phase 3, randomized, double-blind, parallel-group, placebo-controlled, multicenter inpatient study to examine the efficacy and safety of KarXT in adult subjects who are acutely psychotic with a Diagnostic and Statistical Manual Fifth Edition (DSM-5) diagnosis of schizophrenia. The primary objective of the study is to assess the efficacy of KarXT (a fixed combination of xanomeline 125 mg and trospium chloride 30 mg twice daily \[BID\]) versus placebo in reducing Positive and Negative Syndrome Scale (PANSS) total scores in adult inpatients with a DSM-5 diagnosis of schizophrenia. The secondary objectives of the study are to evaluate improvement in disease severity and symptoms, safety and tolerability, and pharmacokinetics in adult inpatients with a DSM-5 diagnosis of schizophrenia.

Interventions

DRUGXanomeline and Trospium Chloride Capsules

Oral 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.

DRUGPlacebo

Placebo Capsules

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

TRIPLE (Subject, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender

ALL

Age

18 Years to 65 Years

Healthy volunteers

Inclusion criteria

1. Subject is aged 18 to 65 years, inclusive, at screening. 2. Subject is capable of providing informed consent. 1. A signed informed consent form must be provided before any study assessments are performed. 2. Subject must be fluent (oral and written) in English or local language to consent 3. Subject has a primary diagnosis of schizophrenia established by a comprehensive psychiatric evaluation based on the DSM-5 criteria and confirmed by Mini International Neuropsychiatric Interview for Schizophrenia and Psychotic Disorder Studies (MINI) version 7.0.2. 4. Subject is experiencing an acute exacerbation or relapse of psychotic symptoms, with onset less than 2 months before screening. 1. The subject requires hospitalization for this acute exacerbation or relapse of psychotic symptoms. 2. If already an inpatient at screening, has been hospitalized for less than 2 weeks for the current exacerbation at the time of screening. 5. Positive and Negative Syndrome Scale total score between 80 and 120, inclusive. Score of ≥4 (moderate or greater) for ≥2 of the following Positive Scale (P) items: 1. Item 1 (P1; delusions) 2. Item 2 (P2; conceptual disorganization) 3. Item 3 (P3; hallucinatory behavior) 4. Item 6 (P6; suspiciousness/persecution) 6. Subjects with no change (improvement) in PANSS total score between screening and baseline (Day -1) of more than 20%. 7. Subject has a CGI-S score of ≥4 at screening and baseline (Day -1) visits. 8. Subject will have been off lithium therapy for at least 2 weeks before baseline and free of all oral antipsychotic medications for at least 5 half-lives or 1 week, whichever is longer, before baseline (Day -1). 9. Subjects taking a long-acting injectable antipsychotic could not have received a dose of medication for at least 12 weeks (24 weeks for INVEGA TRINZA) before baseline visit (Day -1). 10. Subject is willing and able to be confined to an inpatient setting for the study duration, follow instructions, and comply with the protocol requirements. 11. BMI must be ≥18 and ≤40 kg/m2. 12. Subject resides in a stable living situation and is anticipated to return to that same stable living situation after discharge, in the opinion of the investigator. 13. Subject has an identified reliable informant/caregiver. 14. Women of childbearing potential, or men with sexual partners of childbearing potential, must be able and willing to use at least 1 highly effective method of contraception during the study and for 30 days after the last dose of study drug. Sperm donation is not allowed for 30 days after the final dose of study drug.

Exclusion criteria

1. Any primary DSM-5 disorder other than schizophrenia within 12 months before screening (confirmed using MINI version 7.0.2 at screening). Symptoms of mild mood dysphoria or anxiety are allowed as long as these symptoms are not the primary focus of treatment. A screening subject with mild substance abuse disorder within the 12 months before screening must be discussed and agreed upon with the medical monitor before they can be allowed into the study. 2. Subjects who are newly diagnosed or are experiencing their first treated episode of schizophrenia. 3. History or presence of clinically significant cardiovascular, pulmonary, hepatic, renal, hematologic, gastrointestinal, endocrine, immunologic, dermatologic, neurologic, or oncologic disease or any other condition that, in the opinion of the investigator, would jeopardize the safety of the subject or the validity of the study results. 4. Subjects with HIV, cirrhosis, biliary duct abnormalities, hepatobiliary carcinoma, and/or active hepatic viral infections based on either medical history or liver function test results. 5. History or high risk of urinary retention, gastric retention, or narrow-angle glaucoma. 6. History of irritable bowel syndrome (with or without constipation) or serious constipation requiring treatment within the last 6 months. 7. Risk for suicidal behavior during the study as determined by the investigator's clinical assessment and Columbia-Suicide Severity Rating Scale (C-SSRS). 8. Clinically significant abnormal finding on the physical examination, medical history, ECG, or clinical laboratory results at screening. 9. Subjects cannot currently (within 5 half-lives or 1 week, whichever is longer, before baseline \[Day -1\]) be receiving oral antipsychotic medications; monoamine oxidase inhibitors; anticonvulsants (eg, lamotrigine, Depakote); tricyclic antidepressants (eg, imipramine, desipramine); selective serotonin reuptake inhibitors; or any other psychoactive medications except for as needed anxiolytics (eg, lorazepam, chloral hydrate). 10. Pregnant, lactating, or less than 3 months postpartum. 11. If, in the opinion of the investigator (and/or Sponsor), subject is unsuitable for enrollment in the study or subject has any finding that, in the view of the investigator (and/or Sponsor), may compromise the safety of the subject or affect his/her ability to adhere to the protocol visit schedule or fulfill visit requirements. 12. Positive test for coronavirus (COVID-19) within 2 weeks before screening and at screening. 13. Subjects with extreme concerns relating to global pandemics, such as COVID-19, that preclude study participation. 14. Subject has had psychiatric hospitalization(s) for more than 30 days (cumulative) during the 90 days before screening. 15. Subject has a history of treatment resistance to schizophrenia medications defined as failure to respond to 2 adequate courses of pharmacotherapy (a minimum of 4 weeks at an adequate dose per the label) or required clozapine within the last 12 months. 16. Subjects with prior exposure to KarXT. 17. Subjects who experienced any adverse effects due to xanomeline or trospium. 18. Participation in another clinical study in which the subject received an experimental or investigational drug agent within 3 months before screening. 19. Risk of violent or destructive behavior. 20. Current involuntary hospitalization or incarceration.

Design outcomes

Primary

Measure	Time frame	Description
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.

Secondary

Measure	Time frame	Description
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Negative Score at Week 5	From baseline up to Week 5	PANSS negative score is the sum of all PANSS 7 negative symptom scales with a minimum score of 7 and a maximum score of 49. Higher scores indicate more severe symptoms. Participants are rated from 1 to 7 on each symptom scale. The negative symptoms in schizophrenia are the diminution or loss of normal functions. If a participant has a PANSS assessment recorded, and no more than 2 items are missing from the PANSS negative scales, then the PANSS Negative Score will be calculated as the average of the non-missing items multiplied by 7. If 3 or more items are missing (\> 30%) at a particular visit, the respective negative score at the visit will not be calculated and will be treated as missing data. Baseline is defined as the PANSS score at screening.
Positive and Negative Syndrome Scale (PANSS) Negative Marder Factor Score Change From Baseline at Week 5	From baseline up to Week 5	PANSS Marder factor score is the sum of 5 negative scales and 2 general scales (N1. Blunted affect; N2. Emotional withdrawal; N3. Poor rapport; N4. Passive/apathetic social withdrawal; N6. Lack of spontaneity; G7. Motor retardation; and G16. Active social avoidance). Participants are rated from 1 to 7 on each symptom scale. Higher score indicates more severe symptoms. The negative symptoms in schizophrenia are the diminution or loss of normal functions. Baseline is defined as the PANSS score at screening.
Clinical Global Impression-Severity (CGI-S) Score Change From Baseline at Week 5	From baseline up to Week 5	Clinical Global Impression-Severity (CGI-S) Score is a measurement to evaluate severity and treatment response in schizophrenia. Completed independently by a clinician, the CGI-S assesses extremely ill patients, by asking 1 question and providing a rating based upon observed and reported symptoms, behavior, and function in the past 7 days to reflect the average severity level across the 7 days. Higher score indicates more severe illness. The CGI-S categorizes the severity of the illness as: 1 = Normal, not at all ill; 2 = Borderline mentally ill; 3 = Mildly ill; 4 = Moderately ill; 5 = Markedly ill; 6 = Severely ill; and 7 = Among the most extremely ill patients. This scale reflects the total score. Baseline is defined as CGI-S score at screening. The change from baseline in total score is reported.
Number of Participants Who Achieve >=30% Reduction in Positive and Negative Symptoms Scale (PANSS) Total Score From Baseline to Week 5	From baseline up to Week 5	Positive and Negative Syndrome Scale (PANSS) is a scale used for measuring symptom severity of subjects 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. Subjects 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 screening. Note: Floor adjusted data were used for this analysis. Floor adjusted total score = total score - 30.
Number of Participants Experiencing Adverse Events (AEs)	From first dose up to Day 42	An Adverse Event (AE) is defined as any new untoward medical occurrence or worsening of a pre-existing medical condition in a clinical investigation participant administered study treatment and that does not necessarily have a causal relationship with this treatment. Adverse events are graded on a scale from 1 to 5, with Grade 1 being mild and asymptomatic; Grade 2 is moderate requiring minimal, local or noninvasive intervention; Grade 3 is severe or medically significant but not immediately life-threatening; Grade 4 events are usually severe enough to require hospitalization; Grade 5 events are fatal.
Number of Participants Experiencing Cholinergic Symptom Adverse Event	From first dose up to Day 42	The number of participants experiencing adverse events related to procholinergic symptoms (believed to be associated with xanomeline) and anticholinergic symptoms (believed to be associated with trospium) symptoms. Examples of procholinergic symptoms include vomiting, nausea, diarrhea, sweating and hyper-salivation. Examples of anticholinergic include dizziness, confusion, hallucinations, and somnolence.
Change From Baseline in Simpson-Angus Scale Total Score (SAS)	From baseline up to week 5	The Simpson-Angus Scale (SAS) is an established instrument to measure drug-related extrapyramidal syndromes. It is a 10-item testing instrument used to assess gait, arm dropping, shoulder shaking, elbow rigidity, wrist rigidity, leg pendulousness, head dropping, glabella tap, tremor, and salivation. The range of scores is from 0 to 40 with increased scores indicating increased severity. Baseline is defined as the Simpson-Angus Scale score recorded on Day -1.
Change From Baseline in Barnes Akathisia Rating Scale (BARS) Total Score	From baseline up to week 5	The BARS for akathisia is a rating scale used to assess the severity of drug-induced akathisia, or restlessness, involuntary movements and inability to sit still. The range of scores is 0 to 14, with higher scores indicating greater severity. Baseline is defined as the BARS score recorded on Day -1.
Time to Maximum Concentration (Tmax)	At days 8 and 28	Tmax is defined as the time it takes for a drug to reach the maximum concentration (Cmax) after administration of a drug. Dose level 125/30 BID at Week 4 (Visit 8 \[Day 28\]) is reported.
Mean Observed Hemoglobin Levels	From baseline up to Days 21, 35, or early temination	The mean observed Hemoglobin levels are displayed as measured at the specified timepoints. Baseline is defined as first dose. Reference Range: Male: 138 - 172 g/L Female: 121 - 151 g/L
Change From Baseline in Abnormal Involuntary Movement Scale (AIMS) Total Score	From baseline up to week 5	The AIMS is a rating scale that is used to measure involuntary movements known as tardive dyskinesia, which can sometimes develop as a side effect of long-term treatment with antipsychotic medications. This measurement was a 12-item scale to assess orofacial, extremity, and truncal movements as well as the overall severity, incapacitation, and the participant's level of awareness of the movements. Items are scored from 0 (none) to 4 (severe). A higher score indicates more severe dyskinesia. Baseline is defined as the AIMS score recorded on Day -1. The total score is the sum of sub scores for items 1-7. The first 7 items are used to measure the severity of abnormal movements in the orofacial region (4 items: facial muscles, lips, jaw, tongue), upper extremities (1 item), lower extremities (1 item), and trunk (1 item). Change from baseline for the total scores are reported.
Number of Participants Who Experienced Weight Change	From baseline up to week 5	The number of participants who lost weight, maintained their weight, or gained weight between baseline and week 5. Baseline is defined as measurements taken at screening.
Change From Baseline in Body Mass Index (BMI)	From baseline up to week 5	The change in Body Mass Index (BMI) from baseline up to week 5. BMI is a person's weight in kilograms divided by the square of height in meters. Baseline is defined as measurements taken at screening.
Change From Baseline in Waist Circumference	From baseline up to week 5	The change in waist circumference in centimeters from baseline up to week 5. Baseline is defined as measurements taken at screening.
Change From Baseline in Orthostatic Vital Signs - Blood Pressure	From baseline up to week 5	The change from baseline in orthostatic diastolic and systolic blood pressure measured while supine and standing after 2 minutes. Baseline is defined as measurements taken at screening.
Change From Baseline in Orthostatic Vital Signs - Heart Rate	From baseline up to week 5	The change from baseline in orthostatic heart rate measured while supine and standing after 2 minutes. Baseline is defined as measurements taken at screening.
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Positive Score at Week 5	From baseline up to Week 5	PANSS positive score is the sum of all PANSS 7 positive symptom scales with a minimum score of 7 and a maximum score of 49. Higher scores indicate more severe symptoms. 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. If a patient has a PANSS assessment recorded and no more than 2 items are missing from the PANSS positive scales, then the PANSS Positive Score will be calculated as the average of the non-missing items multiplied by 7. If 3 or more items are missing (\> 30%) at a particular visit, the respective positive score at the visit will not be calculated and will be treated as missing data. Baseline is defined as the PANSS score at screening.
Number of Participants Experiencing Clinically Significant Abnormal Physical Examination Results	From baseline up to week 5	The number of participants experiencing clinically significant abnormal physical examination results. Baseline is defined as measurements taken at screening.
Number of Participants Experiencing Each Suicidal Ideation Scale Category as Per Columbia Suicide Severity Rating Scale (C-SSRS)	From screening up to Day 42	C-SSRS assesses suicidal behavior and ideation on a scale with 4 general categories: suicidal ideation, intensity of ideation, suicidal behavior, and actual attempts. C-SSRS comprehensively identifies suicidal events while limiting the over identification of suicidal behavior. The C-SSRS was administered by a trained rater at the site. This study used 2 versions of the C-SSRS. At the Screening Visit, the Lifetime version was completed; for all subsequent visits, the Since Last Visit version of the C-SSRS was administered. Risk for suicidal behavior during the study was determined by the investigator's clinical assessment and C-SSRS as confirmed by the following: * Answering Yes on items 4 or 5 (C-SSRS - ideation) with the most recent episode occurring within the 2 months before screening, or * Answering Yes to any of the 5 items (C-SSRS behavior) with an episode occurring within the 12 months before screening. Non-suicidal, self-injurious behavior is not exclusionary.
Area Under the Plasma Concentration-Time Curve (AUC)	At days 8 and 28	AUC is the total area under the plasma drug concentration-time curve from time zero to 12 hours after drug administration. Dose level 125/30 BID at Week 4 (Visit 8 \[Day 28\]) is reported.
Maximum Concentration (Cmax)	At days 8 and 28	Cmax is the maximum (or peak) serum concentration that a drug achieves in a specified compartment or test area of the body after the drug has been administered and before the administration of a second dose. Dose level 125/30 BID at Week 4 (Visit 8 \[Day 28\]) is reported.
Mean Observed Hematocrit Levels	From baseline up to Days 21, 35, or early temination	The mean observed Hematocrit levels are displayed in percentages as measured at the specified timepoints. Baseline is defined as first dose. Reference Range: Male: 40.7 - 50.3% Female: 36.1 - 44.3%
Mean Observed Erythrocyte Levels	From baseline up to Days 21, 35, or early temination	The mean observed erythrocyte levels are displayed as measured at the specified timepoints. Baseline is defined as first dose. Reference Range: Male: 4.7 - 6.1 10\^12 cells/L Female: 4.2 - 5.4 10\^12 cells/L
Mean Observed Platelets Levels	From baseline up to Days 21, 35, or early temination	The mean observed platelet levels are displayed as measured at the specified timepoints. Baseline is defined as first dose. Reference Range: 150-450 10\^9 cells/L
Mean Observed Leukocytes Levels	From baseline up to Days 21, 35, or early temination	The mean observed leukocytes levels are displayed as measured at the specified timepoints. Baseline is defined as first dose. Reference Range: 4.5-10 10\^9 cells/L
Mean Observed Lymphocytes Levels	From baseline up to Days 21, 35, or early temination	The mean observed lymphocytes levels are displayed as measured at the specified timepoints. Baseline is defined as first dose. Reference Range: 1-4.8 10\^9 cells/L
Mean Observed Activated Partial Thromboplastin Time	From baseline up to Days 21, 35, or early temination	The mean observed activated partial thromboplastin times in seconds are displayed as measured at the specified timepoints. Baseline is defined as first dose.
Mean Observed Prothrombin Time	From baseline up to Days 21, 35, or early temination	The mean observed prothrombin times are displayed as measured at the specified timepoints. Baseline is defined as first dose.
Mean Observed Urinalysis - pH	From baseline up to Days 21, 35, or early temination	The mean observed pH of participants' urine are displayed as measured at the specified timepoints. Baseline is defined as first dose. Urinalysis was completed using dipstick. Urinalysis was not completed if the local dipstick was normal.
Mean Observed Urinalysis - Prolactin	From baseline up to Days 21, 35, or early temination	The mean observed prolactin levels of participants' urine are displayed as measured at the specified timepoints. Baseline is defined as first dose. Urinalysis was not completed if the local dipstick was normal.
The Number of Participants With Positive Drug Screen Results	At screening, at Dat -1, and upon return from departure from study site at any time up to Day 42	A National Institute on Drug Abuse-5 urine drug screen (cannabinoids or marijuana, phencyclidine, amphetamines, opiates, and cocaine) was performed at screening and at baseline (Visit 2a \[Day -1\]). If a participant left the study site, they were to have a urine drug screen and test for alcohol (breathalyzer or urine alcohol level) upon returning to the study site.
The Number of Participants With Elevated Liver Function Test Results	From screening up to Day 42	The liver function test results (ALT, AST, ALP, total bilirubin, GGT) were specifically monitored to watch for any participants who met the FDA drug-induced liver injury (DILI) criteria. A summary of elevated liver function test results by visit is provided. Baseline is defined as measurements taken at screening. Monitoring for DILI criteria includes close observation initiated with ALT or AST \>3 × ULN; discontinuation of treatment should be considered if ALT or AST \>8 × ULN, ALT or AST \>5 × ULN for more than 2 weeks, ALT or AST \>3 × ULN and (total bilirubin \>2 × ULN or international normalized ratio \>1.5), or ALT or AST \>3 × ULN with the appearance of fatigue, nausea, vomiting, right upper quadrant pain or tenderness, fever, rash, or eosinophilia (\>5%).
Change From Baseline in Electrocardiogram (ECG) Mean Heart Rate	From baseline up to Day 35 or early termination	The change from baseline up to Day 35 or early termination in ECG mean heart rate. Baseline is defined as measurements taken at screening.

Countries

Ukraine, United States

Participant flow

Participants by arm

Arm	Count
KarXT All participants assigned to KarXT started on a lead-in dose of KarXT 50/20 (xanomeline 50 mg/trospium chloride 20 mg) BID for the first 2 days (Days 1 and 2) followed by KarXT 100/20 (xanomeline 100 mg/trospium chloride 20 mg) BID for the remainder of Week 1 (Days 3 to 7). At Visit 5 (Day 8), dosing was to be titrated upwards to KarXT 125/30 BID unless the participant experienced AEs from the previous dose of KarXT 100/20 BID. All participants who were increased to KarXT 125/30 BID, depending on clinical response and tolerability, had the option to return to KarXT 100/20 BID for the remainder of the treatment period.	125
Placebo Participants received matching oral placebo treatment twice per day	131
Total	256

Withdrawals & dropouts

Period	Reason	FG000	FG001
Overall Study	Adverse Event	8	7
Overall Study	Changes in condition making participant ineligible for further treatment	1	0
Overall Study	Consent Withdrawn	35	22
Overall Study	Other Reasons	0	1
Overall Study	Progressive Disease	0	4
Overall Study	Protocol Violation	2	2
Overall Study	Suicidal or assaultive behavior	0	2

Baseline characteristics

Characteristic	Placebo	Total	KarXT
Age, Continuous	42.6 Years STANDARD_DEVIATION 12.19	43.1 Years STANDARD_DEVIATION 11.82	43.6 Years STANDARD_DEVIATION 11.44
Ethnicity (NIH/OMB) Hispanic or Latino	14 Participants	32 Participants	18 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	117 Participants	224 Participants	107 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Asian	0 Participants	1 Participants	1 Participants
Race (NIH/OMB) Black or African American	77 Participants	156 Participants	79 Participants
Race (NIH/OMB) More than one race	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Unknown or Not Reported	1 Participants	1 Participants	0 Participants
Race (NIH/OMB) White	53 Participants	98 Participants	45 Participants
Sex: Female, Male Female	27 Participants	65 Participants	38 Participants
Sex: Female, Male Male	104 Participants	191 Participants	87 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk
deaths Total, all-cause mortality	0 / 125	0 / 131
other Total, other adverse events	69 / 125	36 / 128
serious Total, serious adverse events	1 / 125	0 / 128

Outcome results

Primary

Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at 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.

Time frame: From baseline up to Week 5

Population: All participants who were randomized, received at least 1 dose of study drug, had a baseline PANSS assessment, and had at least 1 post-baseline PANSS assessment

Arm	Measure	Value (LEAST_SQUARES_MEAN)	Dispersion
KarXT	Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at Week 5	-20.6 Score on a scale	Standard Error 1.584
Placebo	Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at Week 5	-12.2 Score on a scale	Standard Error 1.552

Secondary

Area Under the Plasma Concentration-Time Curve (AUC)

AUC is the total area under the plasma drug concentration-time curve from time zero to 12 hours after drug administration. Dose level 125/30 BID at Week 4 (Visit 8 \[Day 28\]) is reported.

Time frame: At days 8 and 28

Population: All participants who received at least 1 dose of active study drug and have at least 1 measurable (AUC) plasma concentration of study drug.

Arm	Measure	Group	Value (MEAN)	Dispersion
KarXT	Area Under the Plasma Concentration-Time Curve (AUC)	Trospium	27800 h*pg/mL	Standard Deviation 26000
KarXT	Area Under the Plasma Concentration-Time Curve (AUC)	Xanomeline	50200 h*pg/mL	Standard Deviation 37900

Secondary

Change From Baseline in Abnormal Involuntary Movement Scale (AIMS) Total Score

The AIMS is a rating scale that is used to measure involuntary movements known as tardive dyskinesia, which can sometimes develop as a side effect of long-term treatment with antipsychotic medications. This measurement was a 12-item scale to assess orofacial, extremity, and truncal movements as well as the overall severity, incapacitation, and the participant's level of awareness of the movements. Items are scored from 0 (none) to 4 (severe). A higher score indicates more severe dyskinesia. Baseline is defined as the AIMS score recorded on Day -1. The total score is the sum of sub scores for items 1-7. The first 7 items are used to measure the severity of abnormal movements in the orofacial region (4 items: facial muscles, lips, jaw, tongue), upper extremities (1 item), lower extremities (1 item), and trunk (1 item). Change from baseline for the total scores are reported.

Time frame: From baseline up to week 5

Population: All treated participants with evaluable AIMS total score at the prespecified timepoint

Arm	Measure	Value (MEAN)	Dispersion
KarXT	Change From Baseline in Abnormal Involuntary Movement Scale (AIMS) Total Score	0.0 Units on a Scale	Standard Deviation 0.45
Placebo	Change From Baseline in Abnormal Involuntary Movement Scale (AIMS) Total Score	0.0 Units on a Scale	Standard Deviation 0.15

Secondary

Change From Baseline in Barnes Akathisia Rating Scale (BARS) Total Score

The BARS for akathisia is a rating scale used to assess the severity of drug-induced akathisia, or restlessness, involuntary movements and inability to sit still. The range of scores is 0 to 14, with higher scores indicating greater severity. Baseline is defined as the BARS score recorded on Day -1.

Time frame: From baseline up to week 5

Population: All treated participants with evaluable BARS total score at the prespecified timepoint

Arm	Measure	Value (MEAN)	Dispersion
KarXT	Change From Baseline in Barnes Akathisia Rating Scale (BARS) Total Score	-0.1 Score on a Scale	Standard Deviation 0.75
Placebo	Change From Baseline in Barnes Akathisia Rating Scale (BARS) Total Score	-0.1 Score on a Scale	Standard Deviation 0.88

Secondary

Change From Baseline in Body Mass Index (BMI)

The change in Body Mass Index (BMI) from baseline up to week 5. BMI is a person's weight in kilograms divided by the square of height in meters. Baseline is defined as measurements taken at screening.

Time frame: From baseline up to week 5

Population: All treated participants with evaluable BMI values at the prespecified timepoint

Arm	Measure	Value (MEAN)	Dispersion
KarXT	Change From Baseline in Body Mass Index (BMI)	0.457 kg/m^2	Standard Deviation 1.134
Placebo	Change From Baseline in Body Mass Index (BMI)	0.666 kg/m^2	Standard Deviation 0.57

Secondary

Change From Baseline in Electrocardiogram (ECG) Mean Heart Rate

The change from baseline up to Day 35 or early termination in ECG mean heart rate. Baseline is defined as measurements taken at screening.

Time frame: From baseline up to Day 35 or early termination

Population: All treated participants

Arm	Measure	Value (MEAN)	Dispersion
KarXT	Change From Baseline in Electrocardiogram (ECG) Mean Heart Rate	11.5 beats/min	Standard Deviation 14.94
Placebo	Change From Baseline in Electrocardiogram (ECG) Mean Heart Rate	6.1 beats/min	Standard Deviation 14.62

Secondary

Change From Baseline in Orthostatic Vital Signs - Blood Pressure

The change from baseline in orthostatic diastolic and systolic blood pressure measured while supine and standing after 2 minutes. Baseline is defined as measurements taken at screening.

Time frame: From baseline up to week 5

Population: All treated participants with evaluable blood pressure values at the prespecified timepoint

Arm	Measure	Group	Value (MEAN)	Dispersion
KarXT	Change From Baseline in Orthostatic Vital Signs - Blood Pressure	Supine Systolic Blood Pressure	1.9 mmHg	Standard Deviation 13.07
KarXT	Change From Baseline in Orthostatic Vital Signs - Blood Pressure	Supine Diastolic Blood Pressure	2.2 mmHg	Standard Deviation 10.33
KarXT	Change From Baseline in Orthostatic Vital Signs - Blood Pressure	Standing Systolic Blood Pressure	2.3 mmHg	Standard Deviation 14.07
KarXT	Change From Baseline in Orthostatic Vital Signs - Blood Pressure	Standing Diastolic Blood Pressure	2.7 mmHg	Standard Deviation 9.93
Placebo	Change From Baseline in Orthostatic Vital Signs - Blood Pressure	Standing Diastolic Blood Pressure	0.1 mmHg	Standard Deviation 8.62
Placebo	Change From Baseline in Orthostatic Vital Signs - Blood Pressure	Supine Systolic Blood Pressure	0.4 mmHg	Standard Deviation 13
Placebo	Change From Baseline in Orthostatic Vital Signs - Blood Pressure	Standing Systolic Blood Pressure	0.1 mmHg	Standard Deviation 12.54
Placebo	Change From Baseline in Orthostatic Vital Signs - Blood Pressure	Supine Diastolic Blood Pressure	0.4 mmHg	Standard Deviation 9.3

Secondary

Change From Baseline in Orthostatic Vital Signs - Heart Rate

The change from baseline in orthostatic heart rate measured while supine and standing after 2 minutes. Baseline is defined as measurements taken at screening.

Time frame: From baseline up to week 5

Population: All treated participants with evaluable heart rate values at the prespecified timepoint

Arm	Measure	Group	Value (MEAN)	Dispersion
KarXT	Change From Baseline in Orthostatic Vital Signs - Heart Rate	Supine Heart Rate	11.9 beats/min	Standard Deviation 15.72
KarXT	Change From Baseline in Orthostatic Vital Signs - Heart Rate	Standing Heart Rate	9.86 beats/min	Standard Deviation 16.58
Placebo	Change From Baseline in Orthostatic Vital Signs - Heart Rate	Supine Heart Rate	6.1 beats/min	Standard Deviation 14.02
Placebo	Change From Baseline in Orthostatic Vital Signs - Heart Rate	Standing Heart Rate	5.8 beats/min	Standard Deviation 13.85

Secondary

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

PANSS negative score is the sum of all PANSS 7 negative symptom scales with a minimum score of 7 and a maximum score of 49. Higher scores indicate more severe symptoms. Participants are rated from 1 to 7 on each symptom scale. The negative symptoms in schizophrenia are the diminution or loss of normal functions. If a participant has a PANSS assessment recorded, and no more than 2 items are missing from the PANSS negative scales, then the PANSS Negative Score will be calculated as the average of the non-missing items multiplied by 7. If 3 or more items are missing (\> 30%) at a particular visit, the respective negative score at the visit will not be calculated and will be treated as missing data. Baseline is defined as the PANSS score at screening.

Time frame: From baseline up to Week 5

Population: All participants who were randomized, received at least 1 dose of study drug, had a baseline PANSS assessment, and had at least 1 post-baseline PANSS assessment

Arm	Measure	Value (LEAST_SQUARES_MEAN)	Dispersion
KarXT	Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Negative Score at Week 5	-2.7 Score on a scale	Standard Error 0.412
Placebo	Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Negative Score at Week 5	-1.8 Score on a scale	Standard Error 0.405

Secondary

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

PANSS positive score is the sum of all PANSS 7 positive symptom scales with a minimum score of 7 and a maximum score of 49. Higher scores indicate more severe symptoms. 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. If a patient has a PANSS assessment recorded and no more than 2 items are missing from the PANSS positive scales, then the PANSS Positive Score will be calculated as the average of the non-missing items multiplied by 7. If 3 or more items are missing (\> 30%) at a particular visit, the respective positive score at the visit will not be calculated and will be treated as missing data. Baseline is defined as the PANSS score at screening.

Time frame: From baseline up to Week 5

Population: All participants who were randomized, received at least 1 dose of study drug, had a baseline PANSS assessment, and had at least 1 post-baseline PANSS assessment

Arm	Measure	Value (LEAST_SQUARES_MEAN)	Dispersion
KarXT	Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Positive Score at Week 5	-7.1 Score on a scale	Standard Error 0.499
Placebo	Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Positive Score at Week 5	-3.6 Score on a scale	Standard Error 0.492

Secondary

Change From Baseline in Simpson-Angus Scale Total Score (SAS)

The Simpson-Angus Scale (SAS) is an established instrument to measure drug-related extrapyramidal syndromes. It is a 10-item testing instrument used to assess gait, arm dropping, shoulder shaking, elbow rigidity, wrist rigidity, leg pendulousness, head dropping, glabella tap, tremor, and salivation. The range of scores is from 0 to 40 with increased scores indicating increased severity. Baseline is defined as the Simpson-Angus Scale score recorded on Day -1.

Time frame: From baseline up to week 5

Population: All treated participants

Arm	Measure	Value (MEAN)	Dispersion
KarXT	Change From Baseline in Simpson-Angus Scale Total Score (SAS)	-0.1 Score on a Scale	Standard Deviation 0.56
Placebo	Change From Baseline in Simpson-Angus Scale Total Score (SAS)	-0.1 Score on a Scale	Standard Deviation 0.36

Secondary

Change From Baseline in Waist Circumference

The change in waist circumference in centimeters from baseline up to week 5. Baseline is defined as measurements taken at screening.

Time frame: From baseline up to week 5

Population: All treated participants with evaluable waist circumference values at the prespecified timepoint

Arm	Measure	Value (MEAN)	Dispersion
KarXT	Change From Baseline in Waist Circumference	1.666 Centimeters	Standard Deviation 4.8915
Placebo	Change From Baseline in Waist Circumference	1.697 Centimeters	Standard Deviation 4.8577

Secondary

Clinical Global Impression-Severity (CGI-S) Score Change From Baseline at Week 5

Clinical Global Impression-Severity (CGI-S) Score is a measurement to evaluate severity and treatment response in schizophrenia. Completed independently by a clinician, the CGI-S assesses extremely ill patients, by asking 1 question and providing a rating based upon observed and reported symptoms, behavior, and function in the past 7 days to reflect the average severity level across the 7 days. Higher score indicates more severe illness. The CGI-S categorizes the severity of the illness as: 1 = Normal, not at all ill; 2 = Borderline mentally ill; 3 = Mildly ill; 4 = Moderately ill; 5 = Markedly ill; 6 = Severely ill; and 7 = Among the most extremely ill patients. This scale reflects the total score. Baseline is defined as CGI-S score at screening. The change from baseline in total score is reported.

Time frame: From baseline up to Week 5

Population: All participants who were randomized, received at least 1 dose of study drug, had a baseline PANSS assessment, and had at least 1 post-baseline PANSS assessment

Arm	Measure	Value (LEAST_SQUARES_MEAN)	Dispersion
KarXT	Clinical Global Impression-Severity (CGI-S) Score Change From Baseline at Week 5	-1.1 Score on a scale	Standard Error 0.091
Placebo	Clinical Global Impression-Severity (CGI-S) Score Change From Baseline at Week 5	-0.6 Score on a scale	Standard Error 0.088

Secondary

Maximum Concentration (Cmax)

Cmax is the maximum (or peak) serum concentration that a drug achieves in a specified compartment or test area of the body after the drug has been administered and before the administration of a second dose. Dose level 125/30 BID at Week 4 (Visit 8 \[Day 28\]) is reported.

Time frame: At days 8 and 28

Population: All participants who received at least 1 dose of active study drug and have at least 1 measurable (Cmax) plasma concentration of study drug.

Arm	Measure	Group	Value (MEAN)	Dispersion
KarXT	Maximum Concentration (Cmax)	Trospium	6070 pg/mL	Standard Deviation 7780
KarXT	Maximum Concentration (Cmax)	Xanomeline	9660 pg/mL	Standard Deviation 10500

Secondary

Mean Observed Activated Partial Thromboplastin Time

The mean observed activated partial thromboplastin times in seconds are displayed as measured at the specified timepoints. Baseline is defined as first dose.