The FDA has approved Bristol Myers Squibb’s Cobenfy (xanomeline and trospium chloride) for the treatment of schizophrenia in adults, marking the first new approach to treating the condition in decades. Unlike traditional antipsychotics that target dopamine receptors, Cobenfy is a muscarinic agonist that targets cholinergic receptors. This approval offers a new alternative for patients who have been previously prescribed antipsychotic medications.
A Novel Mechanism of Action
Cobenfy's unique mechanism of action involves targeting the muscarinic M1 and M4 receptors in the brain. Sam Clark, CEO of Terran Biosciences, noted that this is the first new mechanism to treat schizophrenia in at least 50 years. The M4 receptor is thought to underlie the antipsychotic effect, while the M1 receptor may have a cognitive boosting effect. This could address not only the hallucinatory symptoms of psychosis but also the social withdrawal and cognitive impairment associated with schizophrenia.
Addressing the Side Effect Profile
Traditional antipsychotics, which block dopamine signaling, can cause Parkinsonian-like symptoms and tardive dyskinesia. They are also associated with metabolic dysfunction, hormonal changes, and weight gain. Cobenfy does not target the dopamine type two receptor, potentially avoiding these adverse effects. "This is the first time you have an antipsychotic that does not target the dopamine type two receptor at all," said Clark.
Expert Perspectives
Despite the excitement surrounding Cobenfy, some experts urge caution. Kim Mueser and Daniel Fulford, professors of occupational therapy at Boston University, emphasize the need for clinical trials comparing Cobenfy with other antipsychotics. "Until clinical trials are conducted comparing Cobenfy with other antipsychotics, it is unknown how Cobenfy might benefit patients with schizophrenia," Mueser told The Brink.
Dan Troy, former chief counsel of the FDA, believes that the approval of Cobenfy could stimulate further investment and innovation in mental health treatment. "I think that the approval of Cobenfy is going to give people hope," said Troy. "They’ll hopefully take a second look at schizophrenia, neuroscience, and mental health; particularly the fact that this is combining an old medicine with a new medicine to alleviate the side effects. I think that approach will intrigue a number of people."
Challenges and Future Directions
Adherence to schizophrenia medication remains a significant challenge, with nearly half of patients refraining from taking their prescribed medication. Additionally, some patients are skeptical of the healthcare industry, which can lead to disengagement. Real-world data and patient experiences will be crucial in determining the long-term impact of Cobenfy on schizophrenia treatment.
