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An Extension Study to Assess Long-term Safety, Tolerability, and Efficacy of KarXT in Adult Patients With Schizophrenia (EMERGENT-4)

Primary Purpose

Schizophrenia

Status
Active
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Xanomeline and Trospium Chloride Capsules
Sponsored by
Karuna Therapeutics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Schizophrenia

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Subject is aged 18 to 65 years, at time of enrollment into the preceding acute study (KAR-007/009).
  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 in (oral and written) English (United States only) or local language (Ukraine only) to consent.
  3. Subject has completed the treatment period on study drug (through Day 35 -2 days) of Studies KAR-007 or KAR-009.
  4. Subject resides in a stable living situation, in the opinion of the investigator.
  5. Subject has an identified, reliable informant/caregiver willing to be able to address some questions related to certain study visits, if needed. An informant/caregiver may not be necessary if the subject has been the patient of the investigator for ≥1 year.
  6. Women of childbearing potential or men with sexual partners of childbearing potential must be sexually abstinent (in line with their preferred and usual lifestyle) or willing and able to use at least 1 highly effective method of contraception during the study and for at least 7 days after the last dose of KarXT. Sperm donation is not allowed for 7 days after the final dose of KarXT.

Exclusion Criteria:

  1. Risk for suicidal behavior during the study as determined by the investigator's clinical assessment and Columbia-Suicide Severity Rating Scale (C-SSRS).
  2. Any clinically significant abnormality, including any finding(s) from the physical examination, vital signs, ECG, or laboratory test at the end-of-treatment visit of Studies KAR-007 or KAR-009 that the investigator, in consultation with the medical monitor, would consider to jeopardize the safety of the subject.
  3. Female subject is pregnant.
  4. 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.
  5. Subjects with extreme concerns relating to global pandemics such as coronavirus disease 2019 (COVID-19) that preclude study participation.
  6. Risk of violent or destructive behavior.
  7. Subjects participating in another investigational drug or device trial or planning on participating in another clinical trial during the course of the study.

Sites / Locations

  • Pillar Clinical Research
  • Woodland International Research Group
  • Advanced Research Center, Inc.
  • Advanced Research Center Inc
  • CITrials
  • Proscience Research Group
  • Collaborative NeuroScience Research, LLC
  • California Clinical Trial Medical Group
  • Synergy San Diego
  • CNS Network
  • Catalina Research Institute, LLC
  • NRC Research Institute
  • California Neuropsychopharmacology Clinical Research Institute
  • California Neuropsychopharmacology Clinical Research Institute
  • Artemis Institute for Clinical Research
  • Schuster Medical Research Institute
  • Collaborative Neuroscience Research, LLC.
  • Behavioral Clinical Research, Inc.
  • Research Centers of America
  • Innovative Clinical Research, Inc.
  • Atlanta Center for Medical Research
  • iResearch Atlanta, LLC
  • Mitchell L. Glaser
  • Uptown Research Institute
  • AMITA Health Center for Psychiatric Research
  • Pillar Clinical Research
  • Arch Clinical Trials
  • Altea Research Institute
  • Hassman Research Institute
  • Hassman Research Institute
  • Neuro-Behavioral Clinical Research, Inc.
  • Community Clinical Research
  • InSite Clinical Research
  • Pillar Clinical Research, LLC
  • Cherkasy Regional Psychiatric Hospital of Cherkasy Regional Council, Female Department #11, Male Department #12
  • Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov
  • Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine
  • Regional Clinical Psychiatric Hospital No. 3, Adult Psychiatric Department No. 3
  • Kherson Regional Insititution of Mental Care of Kherson Regional Council Male Psychiatric Department #3, Femail Psychiatric Department #10
  • Kyiv Regional Medical Incorporation "Psychiatry", Center for Novel Treatment and Rehabilitation of Psychotic Disorders
  • Lviv Regional Clinical Psychiatric Hospital, Department #20
  • Lviv Regional Clinical Psychiatric Hospital, Department #25
  • Regional Facility for Psychiatric Care of Poltava Regional Council, 2-A acute general psychiatric male ward, 5-B acute, quiet, general psychiatric female ward, Poltava State Medical University, Academic Department of Psychiatry, Addictology and Medical
  • M.I. Pyrogov Vinnytsya National Medical University

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

KarXT

Arm Description

Outcomes

Primary Outcome Measures

Incidence of treatment-emergent adverse events (TEAEs)
The number and percentage of participants with TEAEs will be determined

Secondary Outcome Measures

Incidence of serious treatment-emergent adverse events (TEAEs)
The number and percentage of participants with serious TEAEs will be determined
Incidence of treatment-emergent adverse events (TEAEs) leading to withdrawal
The number and percentage of participants with TEAEs leading to withdrawal will be determined
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at Week 52
The PANSS is a medical scale used for measuring symptom severity of participants with schizophrenia. 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 total score is the sum of all scales with a minimum score of 30 and a maximum score of 210. A decrease in PANSS total score correlates with an improvement in schizophrenia symptoms.
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Positive Score at Week 52
The PANSS rating form contains 7 positive symptom scales, 7 negative system scales, and 16 general psychopathology symptom scales. For positive symptoms in schizophrenia, participants are rated from 1 to 7 on each symptom scale, with a minimum score of 7 and a maximum score of 49. A decrease in PANSS total score correlates with an improvement in schizophrenia symptoms.
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Negative Score at Week 52
The PANSS rating form contains 7 positive symptom scales, 7 negative system scales, and 16 general psychopathology symptom scales. For negative symptoms in schizophrenia, participants are rated from 1 to 7 on each symptom scale, with a minimum score of 7 and a maximum score of 49. A decrease in PANSS total score correlates with an improvement in schizophrenia symptoms.
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Negative Marder Factor Score
The Negative Marder Factor score is derived from the PANSS and consists of the sum of 5 negative scales (N) and 2 general scales (G) (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), with a minimum score of 7 and a maximum score of 49.
Change From Baseline in Clinical Global Impression - Severity (CGI-S) Score at Week 52
The CGI-S modified asked the clinician 1 question: "Considering your total clinical experience, how mentally ill is the participant at this time?" The clinician's answer rated on the following 7-point scale: 1 = normal, not at all ill; 2 = borderline mentally ill; 3 = mildly ill; 4 = moderately ill; 5 = markedly ill; 6 = severely ill; 7 = among the most extremely ill participants.
Percentage of Positive and Negative Syndrome Scale (PANSS) responders (a 30% change in PANSS total score) at Week 52
The PANSS is a medical scale used for measuring symptom severity of participants with schizophrenia. 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 total score is the sum of all scales with a minimum score of 30 and a maximum score of 210. A PANSS responder is defined as a participant with at least a 30% change in PANSS total score compared to baseline at Week 52.

Full Information

First Posted
December 2, 2020
Last Updated
March 16, 2023
Sponsor
Karuna Therapeutics
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1. Study Identification

Unique Protocol Identification Number
NCT04659174
Brief Title
An Extension Study to Assess Long-term Safety, Tolerability, and Efficacy of KarXT in Adult Patients With Schizophrenia (EMERGENT-4)
Official Title
An Open-label Extension Study to Assess the Long-term Safety, Tolerability, and Efficacy of KarXT in Subjects With DSM-5 Schizophrenia
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
February 1, 2021 (Actual)
Primary Completion Date
December 2023 (Anticipated)
Study Completion Date
December 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Karuna Therapeutics

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a Phase 3, multicenter, 53-week, outpatient, open-label extension (OLE) study to evaluate the long-term safety, tolerability, and efficacy of KarXT in subjects with Diagnostic and Statistical Manual-Fifth Edition (DSM-5) schizophrenia who previously completed the treatment period of one of the two Phase 3 double-blind studies, KAR-007 or KAR-009. In this OLE study, all subjects will receive KarXT (a fixed combination of xanomeline 125 mg and trospium chloride 30 mg twice daily [BID]) for up to 52 weeks regardless of treatment assignment in the preceding Phase 3 acute study. The primary objective of the study is to assess the long-term safety and tolerability of KarXT in subjects with a DSM-5 diagnosis of schizophrenia. The secondary objective of this study is to assess the long-term efficacy and monitor trough concentrations of xanomeline and trospium after administration of KarXT.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Schizophrenia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
350 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
KarXT
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Xanomeline and Trospium Chloride Capsules
Other Intervention Name(s)
KarXT
Intervention Description
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 8-364 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. Re-escalation to 125/30 BID or re-titration in cases in which the subject has been off KarXT for a longer period of time (at least a week) is allowed and will require a discussion between the principal investigator and the medical monitor.
Primary Outcome Measure Information:
Title
Incidence of treatment-emergent adverse events (TEAEs)
Description
The number and percentage of participants with TEAEs will be determined
Time Frame
From initial dose through 7 days after the final dose (up to 53 weeks)
Secondary Outcome Measure Information:
Title
Incidence of serious treatment-emergent adverse events (TEAEs)
Description
The number and percentage of participants with serious TEAEs will be determined
Time Frame
From initial dose through 7 days after the final dose (up to 53 weeks)
Title
Incidence of treatment-emergent adverse events (TEAEs) leading to withdrawal
Description
The number and percentage of participants with TEAEs leading to withdrawal will be determined
Time Frame
From initial dose through 7 days after the final dose (up to 53 weeks)
Title
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at Week 52
Description
The PANSS is a medical scale used for measuring symptom severity of participants with schizophrenia. 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 total score is the sum of all scales with a minimum score of 30 and a maximum score of 210. A decrease in PANSS total score correlates with an improvement in schizophrenia symptoms.
Time Frame
Week 52
Title
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Positive Score at Week 52
Description
The PANSS rating form contains 7 positive symptom scales, 7 negative system scales, and 16 general psychopathology symptom scales. For positive symptoms in schizophrenia, participants are rated from 1 to 7 on each symptom scale, with a minimum score of 7 and a maximum score of 49. A decrease in PANSS total score correlates with an improvement in schizophrenia symptoms.
Time Frame
Week 52
Title
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Negative Score at Week 52
Description
The PANSS rating form contains 7 positive symptom scales, 7 negative system scales, and 16 general psychopathology symptom scales. For negative symptoms in schizophrenia, participants are rated from 1 to 7 on each symptom scale, with a minimum score of 7 and a maximum score of 49. A decrease in PANSS total score correlates with an improvement in schizophrenia symptoms.
Time Frame
Week 52
Title
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Negative Marder Factor Score
Description
The Negative Marder Factor score is derived from the PANSS and consists of the sum of 5 negative scales (N) and 2 general scales (G) (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), with a minimum score of 7 and a maximum score of 49.
Time Frame
Week 52
Title
Change From Baseline in Clinical Global Impression - Severity (CGI-S) Score at Week 52
Description
The CGI-S modified asked the clinician 1 question: "Considering your total clinical experience, how mentally ill is the participant at this time?" The clinician's answer rated on the following 7-point scale: 1 = normal, not at all ill; 2 = borderline mentally ill; 3 = mildly ill; 4 = moderately ill; 5 = markedly ill; 6 = severely ill; 7 = among the most extremely ill participants.
Time Frame
Week 52
Title
Percentage of Positive and Negative Syndrome Scale (PANSS) responders (a 30% change in PANSS total score) at Week 52
Description
The PANSS is a medical scale used for measuring symptom severity of participants with schizophrenia. 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 total score is the sum of all scales with a minimum score of 30 and a maximum score of 210. A PANSS responder is defined as a participant with at least a 30% change in PANSS total score compared to baseline at Week 52.
Time Frame
Week 52

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject is aged 18 to 65 years, at time of enrollment into the preceding acute study (KAR-007/009). Subject is capable of providing informed consent. A signed informed consent form must be provided before any study assessments are performed. Subject must be fluent in (oral and written) English (United States only) or local language (Ukraine only) to consent. Subject has completed the treatment period on study drug (through Day 35 -2 days) of Studies KAR-007 or KAR-009. Subject resides in a stable living situation, in the opinion of the investigator. Subject has an identified, reliable informant/caregiver willing to be able to address some questions related to certain study visits, if needed. An informant/caregiver may not be necessary if the subject has been the patient of the investigator for ≥1 year. Women of childbearing potential or men with sexual partners of childbearing potential must be sexually abstinent (in line with their preferred and usual lifestyle) or willing and able to use at least 1 highly effective method of contraception during the study and for at least 7 days after the last dose of KarXT. Sperm donation is not allowed for 7 days after the final dose of KarXT. Exclusion Criteria: Risk for suicidal behavior during the study as determined by the investigator's clinical assessment and Columbia-Suicide Severity Rating Scale (C-SSRS). Any clinically significant abnormality, including any finding(s) from the physical examination, vital signs, ECG, or laboratory test at the end-of-treatment visit of Studies KAR-007 or KAR-009 that the investigator, in consultation with the medical monitor, would consider to jeopardize the safety of the subject. Female subject is pregnant. 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. Subjects with extreme concerns relating to global pandemics such as coronavirus disease 2019 (COVID-19) that preclude study participation. Risk of violent or destructive behavior. Subjects participating in another investigational drug or device trial or planning on participating in another clinical trial during the course of the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Inder Kaul, MD
Organizational Affiliation
Karuna Therapeutics
Official's Role
Study Director
Facility Information:
Facility Name
Pillar Clinical Research
City
Bentonville
State/Province
Arkansas
ZIP/Postal Code
72712
Country
United States
Facility Name
Woodland International Research Group
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72211
Country
United States
Facility Name
Advanced Research Center, Inc.
City
Anaheim
State/Province
California
ZIP/Postal Code
92805
Country
United States
Facility Name
Advanced Research Center Inc
City
Bellflower
State/Province
California
ZIP/Postal Code
90706
Country
United States
Facility Name
CITrials
City
Bellflower
State/Province
California
ZIP/Postal Code
90706
Country
United States
Facility Name
Proscience Research Group
City
Culver City
State/Province
California
ZIP/Postal Code
90230
Country
United States
Facility Name
Collaborative NeuroScience Research, LLC
City
Garden Grove
State/Province
California
ZIP/Postal Code
92845
Country
United States
Facility Name
California Clinical Trial Medical Group
City
Glendale
State/Province
California
ZIP/Postal Code
91206
Country
United States
Facility Name
Synergy San Diego
City
Lemon Grove
State/Province
California
ZIP/Postal Code
91945
Country
United States
Facility Name
CNS Network
City
Long Beach
State/Province
California
ZIP/Postal Code
90806
Country
United States
Facility Name
Catalina Research Institute, LLC
City
Montclair
State/Province
California
ZIP/Postal Code
91763
Country
United States
Facility Name
NRC Research Institute
City
Orange
State/Province
California
ZIP/Postal Code
92868
Country
United States
Facility Name
California Neuropsychopharmacology Clinical Research Institute
City
Pico Rivera
State/Province
California
ZIP/Postal Code
90660
Country
United States
Facility Name
California Neuropsychopharmacology Clinical Research Institute
City
San Diego
State/Province
California
ZIP/Postal Code
92102
Country
United States
Facility Name
Artemis Institute for Clinical Research
City
San Diego
State/Province
California
ZIP/Postal Code
92103
Country
United States
Facility Name
Schuster Medical Research Institute
City
Sherman Oaks
State/Province
California
ZIP/Postal Code
91403
Country
United States
Facility Name
Collaborative Neuroscience Research, LLC.
City
Torrance
State/Province
California
ZIP/Postal Code
90502
Country
United States
Facility Name
Behavioral Clinical Research, Inc.
City
Hollywood
State/Province
Florida
ZIP/Postal Code
33021
Country
United States
Facility Name
Research Centers of America
City
Hollywood
State/Province
Florida
ZIP/Postal Code
33024
Country
United States
Facility Name
Innovative Clinical Research, Inc.
City
Miami Lakes
State/Province
Florida
ZIP/Postal Code
33016
Country
United States
Facility Name
Atlanta Center for Medical Research
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30331
Country
United States
Facility Name
iResearch Atlanta, LLC
City
Decatur
State/Province
Georgia
ZIP/Postal Code
30030
Country
United States
Facility Name
Mitchell L. Glaser
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60622
Country
United States
Facility Name
Uptown Research Institute
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60640
Country
United States
Facility Name
AMITA Health Center for Psychiatric Research
City
Hoffman Estates
State/Province
Illinois
ZIP/Postal Code
60169
Country
United States
Facility Name
Pillar Clinical Research
City
Lincolnwood
State/Province
Illinois
ZIP/Postal Code
60712
Country
United States
Facility Name
Arch Clinical Trials
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63125
Country
United States
Facility Name
Altea Research Institute
City
Las Vegas
State/Province
Nevada
ZIP/Postal Code
89102
Country
United States
Facility Name
Hassman Research Institute
City
Berlin
State/Province
New Jersey
ZIP/Postal Code
08009
Country
United States
Facility Name
Hassman Research Institute
City
Marlton
State/Province
New Jersey
ZIP/Postal Code
08053
Country
United States
Facility Name
Neuro-Behavioral Clinical Research, Inc.
City
North Canton
State/Province
Ohio
ZIP/Postal Code
44720
Country
United States
Facility Name
Community Clinical Research
City
Austin
State/Province
Texas
ZIP/Postal Code
78754
Country
United States
Facility Name
InSite Clinical Research
City
DeSoto
State/Province
Texas
ZIP/Postal Code
75115
Country
United States
Facility Name
Pillar Clinical Research, LLC
City
Richardson
State/Province
Texas
ZIP/Postal Code
75080
Country
United States
Facility Name
Cherkasy Regional Psychiatric Hospital of Cherkasy Regional Council, Female Department #11, Male Department #12
City
Smila
State/Province
Cherkasy Region
ZIP/Postal Code
20708
Country
Ukraine
Facility Name
Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov
City
Dnipro
ZIP/Postal Code
49005
Country
Ukraine
Facility Name
Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine
City
Kharkiv
ZIP/Postal Code
61068
Country
Ukraine
Facility Name
Regional Clinical Psychiatric Hospital No. 3, Adult Psychiatric Department No. 3
City
Kharkiv
Country
Ukraine
Facility Name
Kherson Regional Insititution of Mental Care of Kherson Regional Council Male Psychiatric Department #3, Femail Psychiatric Department #10
City
Kherson
ZIP/Postal Code
73488
Country
Ukraine
Facility Name
Kyiv Regional Medical Incorporation "Psychiatry", Center for Novel Treatment and Rehabilitation of Psychotic Disorders
City
Kyiv
ZIP/Postal Code
04080
Country
Ukraine
Facility Name
Lviv Regional Clinical Psychiatric Hospital, Department #20
City
Lviv
ZIP/Postal Code
79021
Country
Ukraine
Facility Name
Lviv Regional Clinical Psychiatric Hospital, Department #25
City
Lviv
ZIP/Postal Code
79021
Country
Ukraine
Facility Name
Regional Facility for Psychiatric Care of Poltava Regional Council, 2-A acute general psychiatric male ward, 5-B acute, quiet, general psychiatric female ward, Poltava State Medical University, Academic Department of Psychiatry, Addictology and Medical
City
Poltava
ZIP/Postal Code
36013
Country
Ukraine
Facility Name
M.I. Pyrogov Vinnytsya National Medical University
City
Vinnytsya
ZIP/Postal Code
21037
Country
Ukraine

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

An Extension Study to Assess Long-term Safety, Tolerability, and Efficacy of KarXT in Adult Patients With Schizophrenia (EMERGENT-4)

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