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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
Lead sponsor
Assets
Xanomeline / Xanomeline / trospium
Listed sites
158
Recruiting sites
112
Enrollment
426
estimated
Study population
Alzheimer’s disease
Key I/E criteria
•Alzheimer's disease•Amyloid biomarker required (PET/CSF/plasma)•MMSE ≤24•Study 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
Timeline
Milestones
Assets
Drug assets
Study populations
Who this study enrolls
Eligibility
Who can enroll
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:
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.
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
Behavior / neuropsychiatric
5 endpointsChange 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
Change from baseline on the CMAI-IPA Domains at Week 14
Time frame:At Week 14
change from baseline, improvement
Change from baseline on the CMAI Total Score at Week 14
Time frame:At Week 14
change from baseline, improvement
Number of participants with Occurrence of Response at Week 14
Time frame:At Week 14
event count, event
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 endpointsNumber of participants with Adverse Events (AEs)
Time frame:Up to Week 18
event count, event
Number of participants with vital sign abnormalities
Time frame:Up to Week 18
event count, event
Number of participants with 12-lead electrocardiogram (ECG) abnormalities
Time frame:Up to Week 14
event count, event
Other (unclassified)
13 endpointsChange from baseline on the Clinical Global Impressions-Severity (CGI-S) at Week 14
Time frame:At Week 14
change from baseline, improvement
Number of participants with Treatment Emergent AEs (TEAEs)
Time frame:Up to Week 18
event count, event
Number of participants with Serious AEs (SAEs)
Time frame:Up to Week 18
event count, event
Number of participants with AEs leading to study drug withdrawal
Time frame:Up to Week 14
event count, event
Number of deaths
Time frame:Up to Week 18
event count, event
Number of participants with AEs of Special Interest (AESIs)
Time frame:Up to Week 18
event count, event
Barnes Akathisia Rating Scale (BARS)
Time frame:Up to Week 14
descriptive
Abnormal Involuntary Movement Scale (AIMS)
Time frame:Up to Week 14
descriptive
Body Weight
Time frame:Up to Week 14
descriptive
Body Mass Index (BMI)
Time frame:Up to Week 14
descriptive
Number of participants with clinical laboratory abnormalities
Time frame:Up to Week 14
event count, event
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
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 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.