What's This New Hot Flash Pill, Veozah?

What is Veozah?

Now I know Veozah sounds like the name of your auntie from Alabama, but actually, it is a new and potentially important drug (fezolinetant) recently approved by the FDA for the treatment of menopausal hot flashes. This is the first new medication for the treatment of hot flashes in…forever. Thank goodness that new research into the menopausal hot flash has not only yielded a better understanding of the origin but also has discovered what appears to be an effective treatment option for women who cannot take hormones. Fezolinetant is a neurokinin-3 antagonist which simply means it works by blocking receptors in the brain that are involved with temperature regulation. Women aged 40-65 with moderate to severe hot flashes were randomized to receive either 30 or 45mg of fezolinetant. The phase 3 trial recruited women from 97 centers both in the North America and abroad.  The study was conducted for 12 weeks for efficacy and continued for another 40 weeks for safety data.

What did they find?

At the 4 and 12 week study intervals, hot flashes were significantly reduced in both treatment groups. The investigators noted elevated liver enzymes in the study participants, the significance of which is not known.  Before starting Veozah, it is recommended that baseline blood tests to assess liver function be done and repeated every three months for the first year of use. Common side effects included abdominal pain, diarrhea, back pain in addition to the elevated liver enzymes.

Who is it for?

Veozah is nonhormonal, and for women who cannot take hormones and are significantly bothered by hot flashes, this medication may be a much-needed addition to our treatment options. Veozah is only approved by the FDA for hot flashes. It is not expected to have any effect on the myriad of other menopausal symptoms. Candidates for fezolinetant include women with hormone sensitive cancers such as breast or uterine, hereditary clotting disorders or known cardiovascular disease. Known or active liver disease is a contraindication for Veozah.

Menopausal Hormone Therapy or Veozah?

 For those women who do not have contraindications, The Menopause Society has stated that estrogen is THE most effective treatment for menopausal hot flashes.  Not only is hormone therapy the most effective treatment for hot flashes, but it is also the most cost effective solution. It is estimated that a one month supply of Veozah will run about $550. Long-term (>1 yr) safety data for Veozah is not known. For women with multiple menopausal symptoms unrelated to hot flashes, they are not likely to see improvement with Veozah. Menopausal hormone therapy also prevents osteoporosis, treats vaginal and urinary symptoms as well as alleviating many of the associated symptoms of menopause. 

References:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00085-5/fulltext

https://www.fda.gov/news-events/press-announcements/fda-approves-novel-drug-treat-moderate-severe-hot-flashes-caused-menopause