The 'game-changing' treatment for schizophrenia
US poised to approve KarXT as new antipsychotic treatment for disorder, which could offer reduced side-effects
The US Food and Drug Administration (FDA) is poised to regulate a "potential first-in-class antipsychotic", known as KarXT, said Medscape.
About one in 300 people worldwide are affected by schizophrenia, but for decades treatment options have been both static and limited. If the FDA approves the twice-daily pill on Thursday, as it is "widely expected" to do, it will be "the first truly novel treatment" for schizophrenia in more than 70 years, said the Financial Times. The decision on the experimental treatment could "pave the way for its rollout in global markets".
What is schizophrenia?
Schizophrenia is a "long-term mental health condition" which causes a wide range of symptoms, according to the NHS. Often described as "a type of psychosis", its effects mean the patient may not be able to "distinguish their own thoughts and ideas from reality". Symptoms usually emerge in adolescence and can include hallucinations, delusions and social isolation.
Subscribe to The Week
Escape your echo chamber. Get the facts behind the news, plus analysis from multiple perspectives.
Sign up for The Week's Free Newsletters
From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.
From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.
The disorder is thought to result from "genetic predisposition", and can be exacerbated by environmental factors such as stress or drug use, said the FT. The worst flare-ups can cause "psychotic breakdowns that last for weeks".
Schizophrenia does not generally cause people to be violent, but sufferers are highly stigmatised and "frequently pushed to the fringes of society". They are also "vastly overrepresented" in the unemployed, homeless and prison populations in the US. Steve Paul, a neuroscientist who developed the precursor to KarXT, has called the disease the "cancer of psychiatry" because of the sheer damage it does to sufferers, including potentially reducing their life expectancy by almost 30 years compared to the average.
What are the treatment options?
Schizophrenia is usually treated with a combination of cognitive behavioural therapy, community support and antipsychotic medication. The development of antipsychotics in the 1950s was a "milestone" in schizophrenia management, said The Lancet. The hypothesis was that schizophrenia was caused by hyperactive dopamine, so medications that blocked dopamine such as chlorpromazine and, later, clozapine, were "groundbreaking".
But these treatments come with "extensive side-effects", from listlessness to movement disorders and heart disease. That contributes to "underprescribing" by doctors, as well as reluctance of patients to keep taking them. Non-adherence rates are incredibly high: about 75% of patients are thought to discontinue treatment. About a third of people with schizophrenia are resistant to conventional antipsychotic treatment.
The current "pharmaceutical arsenal is limited". Clinical trials for new medications are expensive and, in the case of psychiatric drugs, are difficult to assess due to "strong placebo effects". The result? A "steady loss of enthusiasm and investment" in new treatments.
How does KarXT differ?
KarXT essentially combines an experimental drug for Alzheimer's (xanomeline) with another drug (trospium) which suppresses side-effects associated with antipsychotics.
Developed by Karuna Therapeutics, now part of Bristol Myers Squibb (BMS), it works by targeting receptors in the brain that modulate dopamine release, rather than blocking it directly.
Results of its latest trial, published in January, showed that it significantly reduced acute psychotic symptoms. "You get the high levels of efficacy that you anticipated with the [antipsychotics], however, you don't get the consequence that comes with it," Carlos Dortrait, SVP and general manager of US immunology and neuroscience at BMS, told BioSpace.
"I'm very optimistic and hopeful that [KarXT] will be a breakthrough medication," said Jeffrey Conn, scientific co-founder of Karuna Therapeutics and now professor emeritus of pharmacology at Vanderbilt University, Tennessee.
Are there any downsides?
KarXT "does not have a spotless profile", said BioSpace. There are potential cardiovascular risks, including hypertension, and the long-term efficacy is still unclear. Trials so far have been short-term, and participants were predominantly African American males. Pricing is also a challenge: KarXT could cost up to $20,000 a year, which may limit access.
Factors such as poverty, housing and social stigma also play a significant role in outcomes for people with schizophrenia.
"How much can new therapeutics solve this crisis when you have an underfunded mental health system with an inadequate workforce and a chaotic melange of services?" said Ken Duckworth, chief medical officer of the non-profit organisation National Alliance on Mental Illness. "It's a piece of the puzzle but it's not a panacea."
Create an account with the same email registered to your subscription to unlock access.
Sign up for Today's Best Articles in your inbox
A free daily email with the biggest news stories of the day – and the best features from TheWeek.com
Harriet Marsden is a writer for The Week, mostly covering UK and global news and politics. Before joining the site, she was a freelance journalist for seven years, specialising in social affairs, gender equality and culture. She worked for The Guardian, The Times and The Independent, and regularly contributed articles to The Sunday Times, The Telegraph, The New Statesman, Tortoise Media and Metro, as well as appearing on BBC Radio London, Times Radio and “Woman’s Hour”. She has a master’s in international journalism from City University, London, and was awarded the "journalist-at-large" fellowship by the Local Trust charity in 2021.
-
Today's political cartoons - October 6, 2024
Cartoons Sunday's cartoons - Sunday scaries, in-fighting, and more
By The Week US Published
-
5 fact-checked cartoons about the VP debate
Cartoons Artists take on civil disagreements, admissions, and more
By The Week US Published
-
The Japanese villages where time stood still
The Week Recommends Up to 200 villagers cooperate to thatch a roof in a single day, preserving this beautiful tradition
By The Week UK Published
-
4 tips for coping with election anxiety and stress
The Week Recommends Election news is hard to circumvent. But navigating the politically charged season does not have to be stressful.
By Theara Coleman, The Week US Published
-
The audio industry is working to tackle hearing aid stigma
The Explainer Only 1 in 5 people who could benefit from hearing aids use them, according to the Hearing Loss Association of America
By Justin Klawans, The Week US Published
-
How the brain changes during pregnancy
In The Spotlight 'Baby brain' has some scientific basis but not in the way we first thought
By Chas Newkey-Burden, The Week UK Published
-
Do medical clowns really work?
Under the Radar Growing body of evidence suggests laughter and joy are key ingredients in a patient's recovery – even among adults
By The Week UK Published
-
Psychedelic drugs and treating mental illness
The Explainer Scientists claim hallucinogenics could help treat depression and anxiety, but not everyone is convinced
By Elizabeth Carr-Ellis, The Week UK Published
-
The EEE virus is spreading in the US
The Explainer The mosquito strikes again
By Devika Rao, The Week US Published
-
Mold, bugs at listeria-linked Boar's Head meat plant
Speed Read Food safety inspectors reported many violations at a Virginia plant that has been linked to a nationwide deli meat recall
By Peter Weber, The Week US Published
-
Young adults are in a mental health crisis. Why is little being done?
In the spotlight The kids are, in fact, not at all alright.
By Theara Coleman, The Week US Published