Solriamfetol Reduces EDS, Xanomeline Trospium evaluated for Agitation in AD, Otaneda Explains radiologic markers in MS trials

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Welcome to the Neurology News Network. My name is Louie Pasculli. Here’s a look at this week’s top stories in neurology.

Beginning with Phase 3 data, a multicenter, randomized, double-blind, placebo-controlled phase 3 trial (NCT06103825) conducted across multiple centers in China found that treatment with solriamfetol (Sunosi; Axsome Therapeutics) significantly improved wakefulness and reduced excessive daytime sleepiness (EDS) in adults with obstructive sleep apnea (OSA). The therapy also demonstrated an acceptable safety and tolerability profile over 12 weeks of treatment.¹

Study author Hanrong Cheng, PhD, deputy director of the Department of Sleep Medicine at Shenzhen People's Hospital in Guandong, China, and colleagues observed that at week 12, mean Maintenance of Wakeful Test (MWT) sleep latency increased significantly in the solriamfetol group relative to placebo, with a least-squares mean difference of 11.77 minutes (95% CI, 8.99–14.55; P < .0001). In addition, a greater proportion of patients receiving solriamfetol achieved normalized wakefulness levels, defined as an MWT latency of at least 19.4 minutes.

Subjective sleepiness also improved with treatment. Patients receiving the treatment demonstrated a significantly greater reduction in Epworth Sleepiness Scale (ESS) score compared with placebo, with a between-group difference of –1.8 points (P = .0017) at week 12.¹

Sticking with Phase 3 study news, 2 ongoing phase 3 trials, ADAGIO-1 (NCT07011732) and ADAGIO-2 (NCT07011745), are evaluating the efficacy and safety of Xanomeline–Trospium (X/T; Cobenfy; BMS) for agitation associated with Alzheimer disease (AD), a neuropsychiatric complication affecting approximately half of patients. Presented as a poster at the 2026 AD/PD International Conference in Copenhagen, the trials reflect growing interest in muscarinic receptor modulation as a therapeutic strategy for behavioral symptoms of dementia.²

Despite the high prevalence and clinical burden of agitation in AD, treatment options remain limited, with only 1 FDA-approved therapy currently available. ADAGIO-1 and ADAGIO-2 are identical, randomized, double-blind, placebo-controlled phase 3 studies enrolling approximately 704 total participants aged 55 to 90 years with biomarker-confirmed AD and clinically significant agitation.²

Eligible participants must demonstrate persistent agitation for at least 2 weeks prior to screening, defined using established clinical tools including the Neuropsychiatric Inventory (NPI/NPI-NH), Clinical Global Impressions–Severity (CGI-S), and Cohen-Mansfield Agitation Inventory–International Psychogeriatric Association (CMAI-IPA) criteria.

Finishing up with clinician insight, at the 2026 Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum in San Diego, California, MS expert Daniel Ontaneda, MD, PhD, presented a session titled Rethinking MS Clinical Course Descriptors: Radiological Considerations. His presentation examined how evolving understanding of MS biology and imaging markers may influence the way clinical trials are designed and how treatment effects are evaluated.

During the meeting, Ontaneda, a neuroimmunologist at Cleveland Clinic’s Mellen Center for Multiple Sclerosis Treatment and Research, spoke with NeurologyLive® about the future role of radiologic markers in MS clinical trials. In the discussion, he outlines the lessons learned from traditional MRI endpoints, the challenges of identifying imaging markers that predict progression, and how future studies may better integrate radiologic measures to guide both clinical trial design and individualized patient care.

To read the full interview and to get more direct access to expert insight, head to NeurologyLive.com. Be sure to tune in next week to stay up to date on the latest in neurology. I’m Louie Pasculli, thanks for watching Neurology News Network.

REFERENCES
1. Cheng H, Deng L, Meng Z, et al. Efficacy and Safety of Solriamfetol on Excessive Daytime Sleepiness Associated with Obstructive Sleep Apnea in China: A Phase 3, Multicenter, Double-Blind, Placebo-Controlled Randomized Clinical Trial. CNS Drugs. 2026;40(1):83-98. doi:10.1007/s40263-025-01232-1
2. Ramsay I, Marcus R, Shao Y, Grossberg G, Schieber F, Sepulveda R. Two parallel phase 3 trials to evaluate X/T for the treatment of agitation associated with Alzheimer’s disease (ADAGIO-1/ADAGIO-2). Presented at: 2026 AD/PD Conference; March 17-21; Copenhagen, Denmark. ABSTRACT 533