Neurokinin antagonists improve menopausal sleep disturbance in low-certainty meta-analysis

A systematic review and meta-analysis in Menopause evaluated neurokinin receptor antagonists for sleep disturbance in perimenopausal and postmenopausal women with moderate to severe vasomotor symptoms. Seven placebo-controlled randomized trials involving 3,184 women were included. The outcome was change in PROMIS Sleep Disturbance Short Form 8b scores at 4, 12, and 24 weeks.

The authors reported standardized mean differences favoring treatment of −3.94 at 4 weeks (95% CI, −5.71 to −2.16; 2,869 participants), −3.11 at 12 weeks (95% CI, −4.60 to −1.61; 2,869 participants), and −2.04 at 24 weeks (95% CI, −3.93 to −0.15; 1,798 participants). Subgroup analyses found benefits for both elinzanetant and fezolinetant, with a larger effect for elinzanetant (P < 0.001); this was not a direct head-to-head comparison.

All trials were judged at low risk of bias, but overall evidence certainty was low because of substantial unexplained heterogeneity. Trial sequential analysis met the authors’ thresholds for sufficient cumulative evidence, although this does not resolve heterogeneity. The findings suggest potential sleep benefits in women with bothersome vasomotor symptoms, rather than establishing efficacy for menopausal sleep disturbance generally. Outcomes were patient-reported, and the supplied abstract does not provide safety results or establish the clinical meaning of the reported effect sizes.