Fezolinetant Explained

Width:250
Tradename:Veozah, Veoza
Dailymedid:Fezolinetant
Pregnancy Au:B3
Pregnancy Au Comment:[1]
Routes Of Administration:By mouth
Atc Prefix:G02
Atc Suffix:CX06
Legal Au:S4
Legal Au Comment:[2]
Legal Us:Rx-only
Legal Us Comment:[3]
Legal Eu:Rx-only
Legal Eu Comment:[4] [5]
Protein Bound:51%[6]
Metabolism:CYP1A2, (CYP2C9, CYP2C19 to lesser extent)
Metabolites:ES259564[7]
Elimination Half-Life:9.6h
Excretion:Urine 76.9%, feces 14.7%[8]
Cas Number:1629229-37-3
Pubchem:117604931
Drugbank:DB15669
Chemspiderid:58828046
Unii:83VNE45KXX
Kegg:D11976
Chebi:229236
Chembl:3608680
Synonyms:ESN-364
Iupac Name:(4-fluorophenyl)-[(8''R'')-8-methyl-3-(3-methyl-1,2,4-thiadiazol-5-yl)-6,8-dihydro-5''H''-[1,2,4]triazolo[4,3-a]pyrazin-7-yl]methanone
C:16
H:15
F:1
N:6
O:1
S:1
Smiles:C[C@@H]1C2=NN=C(N2CCN1C(=O)C3=CC=C(C=C3)F)C4=NC(=NS4)C
Stdinchi:1S/C16H15FN6OS/c1-9-13-19-20-14(15-18-10(2)21-25-15)23(13)8-7-22(9)16(24)11-3-5-12(17)6-4-11/h3-6,9H,7-8H2,1-2H3/t9-/m1/s1
Stdinchikey:PPSNFPASKFYPMN-SECBINFHSA-N

Fezolinetant, sold under the brand name Veozah among others, is a medication used for the treatment of hot flashes (vasomotor symptoms) due to menopause.[9] It is a small-molecule, orally active, selective neurokinin-3 (NK3) receptor antagonist which is under development by for the treatment of sex hormone-related disorders. It is taken by mouth. It is developed by Astellas Pharma which acquired it from Ogeda (formerly Euroscreen) in April 2017.[10] [11] [12]

The most common side effects include abdominal pain, diarrhea, insomnia, back pain, hot flush and elevated hepatic transaminases.

Fezolinetant was approved for medical use in the United States in May 2023, and in the European Union in December 2023. Fezolinetant is the first neurokinin 3 (NK3) receptor antagonist approved by the US Food and Drug Administration (FDA) to treat moderate to severe hot flashes from menopause. The FDA considers it to be a first-in-class medication.[13]

Medical uses

Fezolinetant is indicated for the treatment of moderate to severe vasomotor symptoms due to menopause.

History

In May 2017, fezolinetant had completed phase I and phase IIa clinical trials for hot flashes in postmenopausal females. Phase IIa trials in polycystic ovary syndrome patients are ongoing.

In March 2023, results from SKYLIGHT 1, a Phase III clinical study of the treatment of moderate to severe hot flashes due to menopause, were published in The Lancet.[14] [15]

Fezolinetant shows high affinity for and potent inhibition of the NK3 receptor in vitro (Ki = 25 nM, = 20 nM). Loss-of-function mutations in TACR and TACR3, the genes respectively encoding neurokinin B and its receptor, the NK3 receptor, have been found in patients with idiopathic hypogonadotropic hypogonadism. In accordance, NK3 receptor antagonists like fezolinetant have been found to dose-dependently suppress luteinizing hormone (LH) secretion, though not that of follicle-stimulating hormone (FSH), and consequently to dose-dependently decrease estradiol and progesterone levels in females and testosterone levels in males.[16] As such, they are similar to GnRH modulators, and present as a potential clinical alternative to them for use in the same kinds of indications.[17] However, the inhibition of sex hormone production by NK3 receptor inactivation tends to be less complete and "non-castrating" relative to that of GnRH modulators, and so they may have a reduced incidence of menopausal-like side effects such as loss of bone mineral density.

Unlike GnRH modulators, but similarly to estrogens, NK3 receptor antagonists including fezolinetant and MLE-4901 (also known as AZD-4901, formerly AZD-2624) have been found to alleviate hot flashes in menopausal females.[18] [19] This would seem to be independent of their actions on the hypothalamic–pituitary–gonadal axis and hence on sex hormone production. NK3 receptor antagonists are anticipated as a useful clinical alternative to estrogens for management of hot flashes, but with potentially reduced risks and side effects.

The effectiveness of Veozah to treat moderate to severe hot flashes was demonstrated in each of the first 12-week, randomized, placebo-controlled, double-blind portions of two phase III clinical trials. In both trials, after the first 12 weeks, the females on placebo were then re-randomized to Veozah for a 40-week extension study to evaluate safety. Each trial ran a total of 52 weeks. The average age of the trial participants was 54 years old.

The FDA granted the application for fezolinetant priority review designation. The approval of Veozah was granted to Astellas Pharma US, Inc.

Society and culture

Legal status

In October 2023, the Committee for Medicinal Products for Human Use of the European Medicines Agency adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Veoza, intended for the treatment of hot flushes (vasomotor symptoms) associated with menopause. The applicant for this medicinal product is Astellas Pharma Europe B.V.

Fezolinetant was approved for medical use in the United States in May 2023, and in the European Union in December 2023.

Brand names

Fezolinetant is the international nonproprietary name.[20]

Fezolinetant is sold under the brand names Veozah and Veoza.

Notes and References

  1. Web site: Veoza APMDS . Therapeutic Goods Administration (TGA) . 6 March 2024 . 7 March 2024.
  2. Web site: Therapeutic Goods (Poisons Standard—June 2024) Instrument 2024 . Federal Register of Legislation . 30 May 2024 . 10 June 2024.
  3. Web site: Veozah – fezolinetant tablet, film coated . DailyMed . 19 May 2023 . 24 May 2023 . 25 May 2023 . https://web.archive.org/web/20230525031220/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cae9f798-24f9-4580-a4fc-e6c710cbda3c . live .
  4. Web site: Veoza EPAR . European Medicines Agency (EMA) . 7 December 2023 . 27 December 2023 . 26 December 2023 . https://web.archive.org/web/20231226193719/https://www.ema.europa.eu/en/medicines/human/EPAR/veoza . live . Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  5. Web site: Veoza PI . Union Register of medicinal products . 12 December 2023 . 26 December 2023 . 13 December 2023 . https://web.archive.org/web/20231213231231/https://ec.europa.eu/health/documents/community-register/html/h1771.htm . live .
  6. Web site: Fezolinetant . 7 July 2023 . 7 July 2023 . https://web.archive.org/web/20230707162328/https://go.drugbank.com/drugs/DB15669 . live .
  7. Web site: Pharmacokinetic Study of Fezolinetant - an Open-Label, Single and Multiple Dose Study to Evaluate the Pharmacokinetics and Safety of Fezolinetant in Healthy Chinese Female Subjects . 15 April 2022 . 7 July 2023 . 7 July 2023 . https://web.archive.org/web/20230707162503/https://classic.clinicaltrials.gov/ct2/show/NCT04793204 . live .
  8. Web site: Fezolinetant . DrugBank.com . 7 July 2023 . 7 July 2023 . https://web.archive.org/web/20230707162328/https://go.drugbank.com/drugs/DB15669 . live .
  9. FDA Approves Novel Drug to Treat Moderate to Severe Hot Flashes Caused by Menopause . U.S. Food and Drug Administration (FDA) . 12 May 2023 . 13 May 2023 . 13 May 2023 . https://web.archive.org/web/20230513001946/https://www.fda.gov/news-events/press-announcements/fda-approves-novel-drug-treat-moderate-severe-hot-flashes-caused-menopause . live .
  10. Astellas Pharma . Astellas to Acquire Ogeda SA . PR Newswire . 5 November 2021 . 5 November 2021 . https://web.archive.org/web/20211105172557/https://www.prnewswire.com/news-releases/astellas-to-acquire-ogeda-sa-300433141.html . live .
  11. Hoveyda HR, Fraser GL, Dutheuil G, El Bousmaqui M, Korac J, Lenoir F, Lapin A, Noël S . Optimization of Novel Antagonists to the Neurokinin‑3 Receptor for the Treatment of Sex-Hormone Disorders (Part II). ACS Medicinal Chemistry Letters. July 2015. 6. 7. 736–740. 10.1021/acsmedchemlett.5b00117. 26191358. 4499830 .
  12. Web site: Fezolinetant – Ogeda. AdisInsight. 5 November 2021. 5 November 2021. https://web.archive.org/web/20211105172558/https://adisinsight.springer.com/drugs/800039455. live.
  13. New Drug Therapy Approvals 2023 . U.S. Food and Drug Administration (FDA) . January 2024 . PDF . 9 January 2024 . https://web.archive.org/web/20240110032419/https://www.fda.gov/media/175253/download . 10 January 2024 . live .
  14. Lederman S, Ottery FD, Cano A, Santoro N, Shapiro M, Stute P, Thurston RC, English M, Franklin C, Lee M, Neal-Perry G . April 2023 . Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study . The Lancet . 10.1016/S0140-6736(23)00085-5 . 36924778 . 401. 10382 . 1091–1102 . 257498379 .
  15. 13 July 2022 . A Study to Find Out if Fezolinetant Helps Reduce Moderate to Severe Hot Flashes in Women Going Through Menopause (Skylight 1) . . . 29 March 2023 . 29 March 2023 . https://web.archive.org/web/20230329060508/https://clinicaltrials.gov/ct2/show/NCT04003155 . live .
  16. Fraser GL, Ramael S, Hoveyda HR, Gheyle L, Combalbert J . The NK3 Receptor Antagonist ESN364 Suppresses Sex Hormones in Men and Women . J. Clin. Endocrinol. Metab. . 101 . 2 . 417–26 . 2016 . 26653113 . 10.1210/jc.2015-3621 . free .
  17. Fraser GL, Hoveyda HR, Clarke IJ, Ramaswamy S, Plant TM, Rose C, Millar RP . The NK3 Receptor Antagonist ESN364 Interrupts Pulsatile LH Secretion and Moderates Levels of Ovarian Hormones Throughout the Menstrual Cycle . Endocrinology . 156 . 11 . 4214–25 . 2015 . 26305889 . 10.1210/en.2015-1409 . free .
  18. Web site: Gone in a Flash: New Drug Class Targets Menopause Symptom. Medscape. 29 April 2017. 12 May 2017. https://web.archive.org/web/20170512210656/http://www.medscape.com/viewarticle/878262. live.
  19. Web site: Ogeda Announces Positive Data From Phase IIa Trial Of Fezolinetant In The Treatment Of Menopausal Hot Flashes. www.clinicalleader.com. 29 April 2017. 6 January 2017. https://web.archive.org/web/20170106150144/http://www.clinicalleader.com/doc/ogeda-announces-positive-fezolinetant-treatment-menopausal-flashes-0001. live.
  20. ((World Health Organization)) . 2017 . International nonproprietary names for pharmaceutical substances (INN): recommended INN: list 77 . WHO Drug Information . 31 . 1 . 10665/330984 . free . World Health Organization .