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RecruitingPhase 3

A Phase 3 Study to Evaluate the Safety and Efficacy of KarXT + KarX-EC for the Treatment of Agitation Associated With Alzheimer's Disease (ADAGIO-1)

A Phase 3, Randomized, Double-Blind, Placebo-Controlled, Parallel Group Study to Evaluate the Safety and Efficacy of KarXT + KarX-EC for the Treatment of Agitation Associated With Alzheimer's Disease

Assets

Xanomeline / Xanomeline / trospium

Listed sites

158

Recruiting sites

112

Enrollment

426

estimated

Study population

Alzheimer’s disease

Key I/E criteria

Alzheimer's diseaseAmyloid biomarker required (PET/CSF/plasma)MMSE ≤24Study partner/caregiver required

Primary endpoint

Change from baseline on the Cohen-Mansfield Agitation Inventory-International

Footprint

Where this trial recruits

Site locations as reported to ClinicalTrials.gov. Site count is not enrollment count; per-site enrollment is not available from source.

Identifiers

Registered as

Org study IDCN012-0023
NCT IDNCT07011732

Timeline

Milestones

Study first posted2025-06-10actual
Study start2025-07-10actual
Last update posted2026-07-13actual
Primary completion2028-11-24estimated
Study completion2028-12-08estimated

Assets

Drug assets

Study populations

Who this study enrolls

Alzheimer’s disease

Eligibility

Who can enroll

Minimum age55 Years
Maximum age90 Years
SexAll
Healthy volunteersNot accepted

Inclusion criteria

- A diagnosis of Alzheimer's disease (AD) in accordance with the 2024 Alzheimer's Association criteria with one of the following confirmations of AD pathology: i) Historical evidence of AD diagnosis with amyloid positron emission tomography (PET), Aβ42/40 ratio in CSF, pTau181/Aβ42 ratio in CSF or pTau217/Aβ42 ratio in plasma using an Health Authority (HA)-authorized diagnostic assay.

ii) If no historical evidence available: A. A plasma biomarker will be assessed for eligibility if allowed per regulatory requirements. The test cutoff(s) will be based on diagnostic use approval.

B. If a plasma biomarker assay cannot be used or if the assay result is inconclusive, conduct one the following:

Amyloid PET.
Aβ42/40 ratio or pTau181/Aβ42 ratio in CSF using an HA-authorized diagnostic assay.
-Mini-Mental State Examination (MMSE) score of ≤ 24 at Screening (Visit 1).
-Have an identified caregiver who has sufficient contact (approximately 8 hours over a week) and is willing to:

i) Attend all visits and report on participant's status. ii) Oversee participant compliance with medication and study procedures. iii) Participate in the study assessments and provide informed consent to participate in the study.

-History of agitation that meets the International Psychogeriatric Association (IPA) consensus definition for agitation in cognitive disorders with onset at least two weeks prior to Screening (Visit 1).
-AD participants are required to have NPI/NPI-NH Agitation/Aggression score ≥ 4 at Screening (Visit 1) and Baseline (Visit 2).
-CMAI-IPA Total Score ≥ 30 at Screening (Visit 1) and Baseline (Visit 2)

Exclusion criteria

- Medical Conditions: i) Agitation symptoms that are primarily attributable to a condition other than the AD causing the dementia.

ii) History of bipolar disorder, schizophrenia, or schizoaffective disorder. iii) History of (or at high risk for) urinary retention, gastric retention, or narrow-angle glaucoma as evaluated by the Investigator.

iv) Risk of suicidal behavior during the study as determined by the Investigator's clinical assessment and/or C-SSR.

- Prior/Concomitant Therapy: i) Recent history of receiving monoamine oxidase inhibitors, anticonvulsants (eg, lamotrigine, divalproex), mood stabilizers (eg, lithium), tricyclic antidepressants (eg, imipramine, desipramine), or any other psychoactive medications except for as needed anxiolytics (eg, lorazepam).

A. Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors taken at a stable dose for at least 8 weeks prior to Screening (Visit 1) may be permitted.

B. Trazodone may be used as a hypnotic or for agitation if started at least 8 weeks prior to Screening (Visit 1).

C. Mirtazapine may be used as a hypnotic if started at least 8 weeks prior to Screening (Visit 1).

- Other protocol-defined Inclusion/Exclusion criteria apply.

Endpoints (21)

What's being measured

Protocol endpoints and posted registry outcome measures, grouped into outcome categories. Composite endpoints show their component event types. Standard codes (LOINC, SNOMED CT) are shown where available.

Coverage by outcome category

Other (unclassified)
13
Behavior / neuropsychiatric
5
Safety / tolerability / PK
3

Behavior / neuropsychiatric

5 endpoints
Primary/protocol endpoint

Change from baseline on the Cohen-Mansfield Agitation Inventory-International Psychogeriatric Association (CMAI-IPA) Total Score at Week 14

Time frame:At Week 14

change from baseline, improvement

Secondary/protocol endpoint

Change from baseline on the CMAI-IPA Domains at Week 14

Time frame:At Week 14

change from baseline, improvement

Secondary/protocol endpoint

Change from baseline on the CMAI Total Score at Week 14

Time frame:At Week 14

change from baseline, improvement

Secondary/protocol endpoint

Number of participants with Occurrence of Response at Week 14

Time frame:At Week 14

event count, event

Secondary/protocol endpoint

Change from baseline on the Neuropsychiatric Inventory/Neuropsychiatric Inventory -Nursing Home (NPI/NPI-NH) Total Score at Week 14

Time frame:At Week 14

Neuropsychiatric Inventory (NPI)

change from baseline, improvement

Safety / tolerability / PK

3 endpoints
Secondary/protocol endpoint

Number of participants with Adverse Events (AEs)

Time frame:Up to Week 18

event count, event

Secondary/protocol endpoint

Number of participants with vital sign abnormalities

Time frame:Up to Week 18

event count, event

Secondary/protocol endpoint

Number of participants with 12-lead electrocardiogram (ECG) abnormalities

Time frame:Up to Week 14

event count, event

Other (unclassified)

13 endpoints
Secondary/protocol endpoint/low confidence

Change from baseline on the Clinical Global Impressions-Severity (CGI-S) at Week 14

Time frame:At Week 14

change from baseline, improvement

Secondary/protocol endpoint/low confidence

Number of participants with Treatment Emergent AEs (TEAEs)

Time frame:Up to Week 18

event count, event

Secondary/protocol endpoint/low confidence

Number of participants with Serious AEs (SAEs)

Time frame:Up to Week 18

event count, event

Secondary/protocol endpoint/low confidence

Number of participants with AEs leading to study drug withdrawal

Time frame:Up to Week 14

event count, event

Secondary/protocol endpoint/low confidence

Number of deaths

Time frame:Up to Week 18

event count, event

Secondary/protocol endpoint/low confidence

Number of participants with AEs of Special Interest (AESIs)

Time frame:Up to Week 18

event count, event

Secondary/protocol endpoint/low confidence

Barnes Akathisia Rating Scale (BARS)

Time frame:Up to Week 14

descriptive

Secondary/protocol endpoint/low confidence

Abnormal Involuntary Movement Scale (AIMS)

Time frame:Up to Week 14

descriptive

Secondary/protocol endpoint/low confidence

Body Weight

Time frame:Up to Week 14

descriptive

Secondary/protocol endpoint/low confidence

Body Mass Index (BMI)

Time frame:Up to Week 14

descriptive

Secondary/protocol endpoint/low confidence

Number of participants with clinical laboratory abnormalities

Time frame:Up to Week 14

event count, event

Secondary/protocol endpoint/low confidence

Number of participants with suicidal ideation as assessed by the Columbia-Suicide Severity Rating Scale (C-SSRS)

Time frame:Up to Week 18

event count, event

Secondary/protocol endpoint/low confidence

Severity of benign prostatic hyperplasia in male participants as assessed by International Prostate Symptom Score (IPSS)

Time frame:Up to Week 14

descriptive

Provenance

Sources

Trial identity, design, statusClinicalTrials.gov API v2
Snapshot dateJuly 21, 2026
Endpoint classificationDelfa ADRD endpoint taxonomy
Results tableno registry results posted yet

Trial facts come from public ClinicalTrials.gov records. Endpoint categories are Delfa's classification of those records, not a ClinicalTrials.gov field. All figures reflect the July 21, 2026 snapshot.