FEZOLINETANT and elinzanetant were both effective and safe in reducing vasomotor symptoms in menopausal women, with elinzanetant offering additional benefits for sleep quality and fewer adverse events.
Vasomotor symptoms, including hot flushes and night sweats, are common among menopausal women and can significantly impact quality of life. This study aimed to evaluate the efficacy and safety of two non-hormonal therapies, fezolinetant and elinzanetant, for managing these symptoms. Randomised controlled trials (RCTs) were systematically reviewed to compare the effectiveness of these drugs against placebo, focusing on symptom frequency and severity, as well as adverse events.
A total of seven RCTs involving 4,087 menopausal women were analysed. The Mantel–Haenszel method and I² statistics were used to assess data heterogeneity and calculate effect sizes. Fezolinetant at 30 mg and 45 mg doses reduced vasomotor symptom frequency by 2.16 (95% CI, 1.54–2.79) and 2.54 (95% CI, 1.86–3.21) episodes per day, respectively. Elinzanetant 120 mg achieved a greater reduction of 2.99 episodes per day (95% CI, 1.74–4.23). Similarly, symptom severity scores were reduced by 0.20 (30 mg fezolinetant), 0.24 (45 mg fezolinetant), and 0.36 (120 mg elinzanetant). Elinzanetant was particularly beneficial in improving sleep quality, with a mean improvement of 4.65 points (95% CI, 3.73–5.56). Moreover, elinzanetant was associated with fewer drug-related adverse events (11.70% vs 20.75%; RR, 0.57; 95% CI, 0.39–0.82) and headaches (2.54% vs 8.0%; RR, 0.32; 95% CI, 0.16–0.64).
These findings highlight the efficacy of fezolinetant and elinzanetant in managing vasomotor symptoms in menopausal women, with elinzanetant showing superior benefits in reducing symptom frequency and severity, improving sleep, and minimising adverse effects. In clinical practice, elinzanetant may be particularly advantageous for women experiencing sleep disturbances or concerned about side effects. Future research should explore the long-term safety and effectiveness of these treatments, as well as their potential role in broader menopausal symptom management strategies.
Abigail Craig, EMJ
Reference
Menegaz De Almeida A et al. Fezolinetant and elinzanetant therapy for menopausal women experiencing vasomotor symptoms: a systematic review and meta-analysis. Obstet Gynecol. 2025; DOI: 10.1097/AOG.0000000000005812.
