Veozah (Fezolinetant) for Menopausal Vasomotor Symptoms
Veozah is an effective non-hormonal treatment for moderate-to-severe hot flashes and night sweats in menopause, demonstrating significant reductions in both frequency and severity of vasomotor symptoms with a generally favorable safety profile, though liver enzyme monitoring is required. 1, 2
Benefits
Efficacy for Vasomotor Symptoms
- Fezolinetant significantly reduces hot flash frequency by approximately 2-2.5 episodes per day compared to placebo at 12 weeks, with improvements observable within the first week of treatment 2
- Severity of vasomotor symptoms decreases significantly, with reductions maintained over 52 weeks of continuous therapy 2
- The medication works through neurokinin 3 (NK3) receptor antagonism in the central nervous system, modulating thermoregulatory neurons without hormonal effects 1, 3
Non-Hormonal Alternative
- Provides a critical option for women who cannot or do not wish to use hormone therapy, addressing a significant unmet need since up to 80% of menopausal women experience vasomotor symptoms 4, 3
- Oral administration at 45 mg once daily offers convenient dosing with proportional pharmacokinetics 3
Quality of Life Impact
- Improvements in vasomotor symptoms are sustained throughout treatment, potentially enhancing overall well-being, though further characterization of effects on mood and sexual function requires investigation 2
Risks and Adverse Effects
Liver Enzyme Elevations
- Liver enzyme elevations represent the most clinically significant safety concern, though incidence is low (0-2% across treatment groups in phase 3 trials) 2
- These elevations are generally asymptomatic, transient, and resolve either during continued treatment or after discontinuation 2
- Regular liver function monitoring is required during fezolinetant therapy 4
Common Adverse Events
- Treatment-emergent adverse events occurred in 37-43% of fezolinetant-treated patients versus 45% with placebo during the first 12 weeks, indicating a safety profile comparable to placebo 2
- Side effects are generally mild when they occur 3
- The specific nature of common adverse events requires monitoring but did not result in substantially higher discontinuation rates than placebo 2
Treatment Discontinuation
- Discontinuation rates varied (7-18% across fezolinetant groups vs 13% for placebo before week 12), primarily due to adverse events or participant withdrawal 2
Clinical Implementation
Dosing
- The recommended dose is 45 mg orally once daily, which demonstrated superior efficacy compared to the 30 mg dose in reducing vasomotor symptom frequency 2
Monitoring Requirements
- Baseline liver function tests must be obtained before initiating therapy 4
- Periodic liver enzyme monitoring is mandatory during treatment to detect asymptomatic elevations 4, 2
- Assess for resolution of liver enzyme abnormalities if they occur, with consideration for treatment discontinuation if clinically indicated 2