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."
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.
-
When did divorce begin?
The Explaine Couples have always split up, but the institution has undergone major changes over the years
By David Faris
-
What are your retirement savings account options?
The explainer The two main types of accounts are 401(k) plans and individual retirement accounts (IRAs)
By Becca Stanek, The Week US
-
7 tranquil hotels worth the trek
The Week Recommends Find serenity off the beaten path
By Catherine Garcia, The Week US
-
Hantavirus: the rare pathogen linked to rodents that attacks the lungs
The Explainer Despite the low risk of contracting it, the virus could be potentially deadly
By Theara Coleman, The Week US
-
The tobacco industry could be the beneficiary of health agency cuts
The explainer Anti-tobacco initiatives may go up in smoke
By Devika Rao, The Week US
-
Full-body scans: are Neko Health and the like more panic than panacea?
The Explainer Hailed as the 'future of medicine' by some, but not all experts are convinced
By The Week UK
-
Mental health: a case of overdiagnosis?
Talking Point Issues at 'the milder end of the spectrum' may be getting wrongly pathologised
By The Week UK
-
Washwood Heath: Birmingham's pioneering neighbourhood health service
In the Spotlight NHS England chair says there is a 'really good argument this is the model for the future'
By The Week UK
-
The UK's first baby born to woman with womb transplant
The Explainer 'Astonishing' medical breakthrough, the culmination of 25 years of research, could pave the way for more procedures to combat uterine infertility
By Harriet Marsden, The Week UK
-
Fighting against fluoride
Feature A growing number of communities are ending water fluoridation. Will public health suffer?
By The Week US
-
DVT: what to know about the blood clot plaguing NBA players
The Explainer Multiple players have been diagnosed with deep vein thrombosis over the past few months
By Theara Coleman, The Week US