Meta-analysis estimates similar hot flash efficacy for fezolinetant and elinzanetant

A model-based meta-analysis published in Menopause evaluated neurokinin receptor antagonists for menopausal hot flashes. Researchers searched four databases and registries through October 30, 2025, for placebo-controlled randomized trials. Pharmacodynamic models characterized dose-response relationships and treatment effects over time after accounting for placebo response. The supplied report did not specify the number of trials or participants.

Both fezolinetant and elinzanetant showed rapid onset, an early efficacy plateau, and dose-dependent effects. At the doses described as recommended, modeled reductions in hot flash frequency were 20.6% with fezolinetant 45 mg and 19.6% with elinzanetant 120 mg. Across fezolinetant doses of 15–180 mg, estimated reductions increased from 10.2% to 33.4%. Indirect comparisons using previously published model estimates suggested greater effects than paroxetine's 14.8% reduction. At 12 weeks, the fezolinetant and elinzanetant effects corresponded to approximately 52% and 49% of the estradiol effect, respectively.

These estimates provide context for nonhormonal treatment selection but do not establish comparative efficacy through head-to-head trials. Placebo responses were higher in neurokinin antagonist trials than in other nonhormonal treatment studies and comparable to those in hormone therapy trials. Differences across trials may therefore influence comparisons. The supplied report did not provide uncertainty estimates or comparative safety findings.