I believe it was during the Morgan Stanley conference that the CEO was asked about competition in the dementia-related psychosis space. He said competition "is a long way off."
Even if Karuna's DRP efficacy/safety data are stellar, it will have to run a large confirmatory trial. That could take up to 2 years to read out and then possibly another year for regulatory approval. During that time, Acadia will be running clinical trials for its own muscarinic compounds; this is why it inked an agreement with Vanderbilt this past May.
There are antipsychotic drugs that have failed clinical trials in Alzheimer's psychosis. Abilify is one. Up to now, even those shown to work cannot be used as their side-effect baggage exacts too high a price in a frail and elderly population. So Karuna will have quite a high bar to clear. It may just do that, as its schizophrenia data were spectacular.
My guess is that pimavanserin will still be the leading drug for DRP patients for quite some time. After numerous KOL checks, Stifel analyst Paul Matteis changed his mind about pimavanserin (previously he was bearish). This is what he wrote back in July:
We’re now more optimistic on pimavanserin in Dementia (i.e. Alzheimer’s) Related Psychosis for a few reasons. For one, from our KOL checks, the prescribing equation in Alzheimer’s is fundamentally different. In PDP the main concern is controlling psychosis while avoiding motor-related side effects, but most physicians are comfortable managing this risk with low dose quetiapine, an old/cheap drug. In ADP the issues are worsening cognition, sedation, weight/metabolic issues and a risk of death, and while pimavanserin may still have a (modified) black box warning, the prevailing view we’ve heard from specialists is that the drug’s differentiated safety profile makes it a go-to option in Alzheimer’s.
Hopefully AXGT works out for you. There was a lot of enthusiasm three years ago about the drug it bought from Glaxo for Alzheimer's (interpidine) along with would-be pimavanserin competitor nelotanserin. Both drugs flopped in the clinic. AXGT's stock fell 70%, and the company ended up doing an 1-for-8 reverse split.