RETROSPECTIVE ANALYSIS OF REAL-WORLD TRANSITION STRATEGIES FOR XANOMELINE AND TROSPIUM CHLORIDE IN ADULT PATIENTS WITH SCHIZOPHRENIA

Approximately 30%-50% of adults with schizophrenia switch antipsychotic medication within 6-24 months of treatment initiation. This study aims to analyze retrospective real-world data from psychiatry healthcare providers (HCPs) to describe the methodology utilized in successfully transitioning adults with schizophrenia from other antipsychotic medications to xanomeline and trospium chloride (KarXT).

Methods

This retrospective study of adults with schizophrenia who have transitioned to KarXT after previous treatment with a typical or atypical antipsychotic was conducted using an electronic survey sent to psychiatry HCPs. Successful transition was defined as maintained treatment with KarXT for ≥1 month with no discontinuation. Data were de-identified at the time of collection.

Results

Data collection is ongoing. During an interim evaluation as of August 29, 2025, 90 patients were 59% male, 69% White, 13% Hispanic/Latino, and 12% African American. Top reasons for previous antipsychotic medication discontinuation were lack of adequate control of positive symptoms and worsened or lack of improvement of negative symptoms. The majority transitioned using a cross-titration approach over 2-4 weeks. Previous antipsychotics were most often tapered by 25% (36%) or 50% (33%) per step, and KarXT was up-titrated from 50 mg/20 mg to 100 mg/20 mg or 125 mg/30 mg over the titration period. Most HCPs provided their patients with an antiemetic either as a prophylactic treatment (21%) or as needed (44%) if nausea/vomiting occurred.

Conclusions

A variety of real-world strategies have been implemented by HCPs to transition adults with schizophrenia to the novel KarXT treatment. Most common strategies utilized in successful switches include cross-titration and consideration of an antiemetic medication for the transient nausea and vomiting that may occur during titration.

Learning Objective 1: To gain an understanding of how psychiatric healthcare providers are transitioning adults with schizophrenia from their current antipsychotic to a novel agent, xanomeline and trospium chloride (KarXT), and identifying strategies used to mitigate potential side effects.

Learning Objective 2: To ascertain the demographics of real-world patients with schizophrenia in the United States treated with KarXT and the reasons for switching from a previous antipsychotic.

References

: 1. Khandker R, Mohit B, Fonseca E, et al: Treatment discontinuation and switching of antipsychotics among adult patients with schizophrenia in the United States. Schizophrenia Res 2025; 283:152-162 2. Ramey OL, Silva Almodovar A: Xanomeline-trospium: a novel therapeutic for the treatment of schizophrenia. Ann Pharmacother 2025; 59:937-950