Balancing the Benefits and Risks of Xanomeline and Trospium Chloride Capsules

In this segment of our latest HCPLive Special Report on the recent approval of xanomeline and tropism chloride capsules (Cobenfy) for schizophrenia, conversation shifts to the critical issue of medication adherence in patients with schizophrenia. Research has indicated that adherence rates for oral medications have dropped below 50%. Rishi Kakar, MD, lead investigator of the EMERGENT trials, opened the conversation by emphasizing the multifaceted reasons behind nonadherence, highlighting that medication frequency, tolerability, and caregiver perspectives play significant roles.

Andrew Cutler, MD, expanded on the topic, explaining that factors such as inadequate efficacy, intolerable adverse events, and anosognosia can contribute to low adherence rates in patients with mental illness.

The conversation also touched on the advantages of long-acting injectable (LAI) antipsychotics, which are increasingly being adopted in clinical practice. Cutler and Kakar discuss the benefits of LAIs in terms of convenience and improved tolerability, especially for patients who struggle with daily medication reminders. They acknowledge the potential for new muscarinic agonists to be developed into LAIs, while also stressing the importance of maintaining oral medication options for patients who may not prefer injectables.

Series Segments:

• Introductions
• Mechanism of Action of Xanomeline and Trospium Chloride Capsules
• Applying EMERGENT Trial Results to Real-World Clinical Practice for Schizophrenia
• Balancing the Benefits and Risks of Xanomeline and Trospium Chloride Capsules
• Unmet Needs, Future Research in Schizophrenia and Muscarinic Agonists

Subject Matter Experts

• Sam Clark, MD, PhD, (Moderator) is a former practicing psychiatrist and is the founder and chief executive officer of Terran Biosciences.
• Andrew Cutler, MD, is a clinical associate professor in the Department of Psychiatry and Behavioral Sciences at SUNY Upstate Medical University and the chief medical officer of the Neuroscience Education Institute.
• Rishi Kakar, MD, is a psychiatrist based out of southern Florida as well as the medical director and chief scientific officer of Segal Trials. Kakar served as the principal investigator on the pivotal EMERGENT trials.

Relevant disclosures for Cutler include Karuna, Bristol Myers Squibb, and others. Relevant disclosures for Kakar include Karuna, Bristol Myers Squibb, and others. Relevant disclosures for Clark include Terran Biosciences.