Takeaways
- Vasomotor symptoms, characterized by sudden sensations of warmth, primarily above the waist, are common during menopause due to changes in estrogen levels.
- Fezolinetant is a novel treatment for hot flashes. It works by blocking the activity of neurons in the hypothalamus that become sensitive and trigger hot flashes in the absence of estrogen.
- Fezolinetant remains effective even for individuals who have previously used hormone therapy. Research has shown that it effectively manages hot flashes in such individuals, highlighting its versatility as a treatment option.
- Studies have demonstrated that fezolinetant is effective in reducing hot flashes, with an average 60% reduction within 12 weeks for individuals with moderate to severe symptoms.
- Fezolinetant is a low-risk treatment option with a low side effect profile. It is suitable for individuals who cannot use hormones due to medical reasons or concerns.
Contemporary OB/GYN:
Hi, I'm Celeste Krewson with Contemporary OB/GYN and I'm here with Dr. Neal-Perry, to discuss fezolinetant for vasomotor symptoms. Do you want to introduce yourself?
Genevieve Neal-Perry, MD:
Hi, Celeste, I'm Genevieve Neal-Perry. I am a reproductive endocrinologist. I have been trained in OBGYN and REI. I am a professor at the University of North Carolina and department chair. I've been doing research in a space that applies for the past 20 years, both with clinical as well as basic science subjects.
Contemporary OB/GYN:
So, to get started, can you briefly go over how vasomotor symptoms impact the quality of life in menopausal women?
Neal-Perry:
Yeah. So yeah, let's just start off by saying what is a vasomotor symptom? Vasomotor symptoms are just quick onset of feeling warm, it's primarily above the waist. And so, it's not the same as how you feel warm when you exercise, it's just a spontaneously feeling more flush. And it's most commonly associated with changes or the loss of estrogen. So, vasomotor symptoms are very common, and people who are making their transition in terms of the menopause and then menopausal people. And when they’re moderate to severe and are frequent, it really can disrupt the quality of life from the perspective of loss of sleep. People may feel like they have brain fog and often describe for people who are having this experience and their ability to just kind of think clearly may not be as intact. For people who have frequent and intense hot flashes, it also is associated with heart disease, it can be associated with Alzheimer's disease later in life. And so, there are many things that vasomotor symptoms can be associated with.
Contemporary OB/GYN:
And can you discuss how fezolinetant impacts vasomotor symptoms?
Neal-Perry:
Yeah, so before I even talk about how, how fezolinetant impacts them, I'll just talk a little bit about what the origin of hot flashes are, and why fezolinetant has actually been so important in terms of how we think about hot flashes. So, as I've said, hot flashes are related to the loss or changes in the amount of estrogen that the brain is exposed to. And specifically, there are neurons in the brain, in the hypothalamus, which is an area that controls your metabolism and controls sleep, it controls your sensation of feeling warm. There are neurons called kisspeptin KNDy neurons. So, they express your peptides called kisspeptin, neurokinins, and dynorphin. And these neurons in the absence of estrogen become very sensitive and they release a hormone that then triggers these hot flashes. And so, the way that fezolinetant works is it actually blocks the activity of these neurons and it blocks the effects of these neurons. So, it's a really novel treatment, whereas estrogen, it affects these neurons, but it also affects lots of other areas of the brain in the body. And so, that's what's unique about fezolinetant, and that's how it actually blocks hot flashes.
Contemporary OB/GYN:
And how are these functions impacted by hormone therapy history?
Neal-Perry:
Okay, great question. So, if someone has used hormonal therapy in the past, the use of fezolinetant is still as effective. And we've actually had data that shows people who've used hormones in the past, if they use fezolinetant it’s effective in terms of management of their hot flashes. So, keep in mind, fezolinetant and estradiol actually work, although they work kind of the funnel is the same, but the effect in terms of the specificity is different.
Contemporary OB/GYN:
And how can physicians address patient expectations related to fezolinetant?
Neal-Perry:
Yeah. So, in our studies and looking at hot flashes, we only included people who have moderate to severe hot flashes, and that's a requirement for the FDA. And what we saw in those individuals within a couple of days, there was an improvement in hot flashes, and within 12 weeks, there was about a 60% reduction in hot flashes on average. So that means that some people were more some people were less but it's a significant reduction, and it's much more than what you would see if you were using a placebo with a placebo, meaning a tablet that looks like the medication, but that's not the medication.
Contemporary OB/GYN:
That's great. We're just about ready to wrap up, but is there anything you want to add first?
Neal-Perry:
Yeah, I would say, you know, when thinking about fezolinetant for our providers that are providing care for people who experience hot flashes, things that are really important to appreciate is that for people who are either not able to use hormones, for medical reasons, for people who have concerns about using hormones, fezolinetant is really a great alternative. It has a low side effect, or risk profile, and it is really effective and works quite quickly. It is effective in populations that we often are worried about using hormonal therapy in such as obese individuals where you worry about the risk for clots. You don't have that same concern with fezolinetant. And in populations of particularly women of color where the burden of hot flashes is much higher, it's also highly effective in that population. So, it's a great new drug and it's quite specific in terms of how it works, and it's really good for providers to know they have a new drug in their pocket that they can use for patients who are affected by hot flashes.
Contemporary OB/GYN:
Well, thank you for speaking with me today.
Neal-Perry:
Thank you, Celeste. It was really nice to meet you. And thank you for talking about this really important topic of hot flashes.
