ReviewThe Psychiatric quarterly2026
Methodological Concerns in a Recently Published Systematic Review and Meta-Analysis of Xanomeline-Trospium in Schizophrenia : Re: Azargoonjahromi A, Nasiri H. Efficacy and Safety of KarXT (Xanomeline-Trospium; Cobenfy™) in Schizophrenia: A Systematic and Meta-Analysis Review of Randomized Controlled Trials. Psychiatric Quarterly. 2025. https://doi.org/10.1007/s11126-025-10226-7.
Review in The Psychiatric quarterly, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This letter addresses significant methodological limitations in a recently published systematic review and meta-analysis evaluating the efficacy and safety of xanomeline-trospium (KarXT) in schizophrenia. A critical unit-of-analysis error is identified in the original review's Table 1, wherein multiple secondary and post hoc publications from a single randomized controlled trial (EMERGENT-1) were extracted and treated as completely independent studies. This unit-of-analysis error violates statistical independence assumptions and likely contributed to an implausible pooled effect size; however, additional discrepancies in data extraction or effect-size calculation may also have influenced the pooled estimate (d = 0.08) that sharply contradicts individual trial data. Additionally, the review lacks registered protocol details, structured risk-of-bias reporting, and safety outcome pooling. Readers and clinicians are cautioned against interpreting the pooled conclusions in isolation.
Identifiers
42543467What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.