New brain-based medicine fezolinetant to cure hot flashes during menopause
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Leading doctors have reportedly developed a medicine that prevents hot flashes by acting directly on the brain could transform treatments for the problemthat a lot of women face during menopause. Menopause is a natural biological process that marks the end of a woman's reproductive years.
Hot flashes are a common symptom experienced by many women during menopause and are characterised by a sudden feeling of warmth that spreads across the body, often accompanied by sweating, flushing of the skin, and an increased heart rate. They can occur during the day or at night, disrupting sleep and causing discomfort.
It is related to hormonal changes that occur during menopause, causinga decrease in estrogen levels and is thought to affect the hypothalamus in the brain. Hypothalamusis responsible for regulating body temperature and an effect on it leads to a misinterpretation of the body's temperature and triggers hot flashes.
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Experts claimed the medication fezolinetant might be revolutionary for the hundreds of thousands of women in the UK who cannot take hormone replacement therapy (HRT) after the US approved the first non-hormonal menopause pill, produced by Astellas Pharma. The medication received a licence in the US on May 12 and may receive approval for usage in the UK by year's end.
“This is going to be a completely blockbuster drug,” said an endocrinologist at Imperial College London, Prof Waljit Dhillo. He led a trial in 2017 that led to the development of the medication.
“It’s like a switch. Within a day or two the flushes go away. It’s unbelievable how well these drugs work. It’s going to be completely game-changing for a lot of women.”
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The medication, which is being evaluated by the European Medicines Agency (EMA), blocks neurokinin-3, a brain protein that has a special function in menopausal women's body temperature regulation.
After 12 weeks of usage, fezolinetant decreased the incidence of hot flushes in women with moderate or severe symptoms by around 60 per cent, according to a major clinical trial that was published in March, compared to a 45 per centreduction in those who got a placebo. Women also reported that the medication increased the quality of their sleep and lessened the severity of their hot flashes.
“What’s really amazing about these drugs is how quickly they work and how big an effect they have,” said Prof Richard Anderson, a co-director of the Centre for Reproductive Health at the University of Edinburgh.
“Typically, estrogen takes several weeks to have an effect. With these, women are reporting effects from the first tablet.”
Hot flashes disrupt everyday life in about 70 per centof menopausal women and are described as "near intolerable" by 10 to 20 per centof them.
Nearly twomillion women in England received at least one HRT prescription each year, however, these treatments are not recommended for anyone with untreated high blood pressure, a history of blood clots, breast or ovarian cancer, or blood clots.
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They are the result of years of careful study by US neuropathologist Prof. Naomi Rance, who pinpointed a particular set of neurons that expand in menopausal women's brains. Rance revealed that these neurons emit the protein neurokinin-B, which may cause hot flashes by detecting minute temperature fluctuations in the tails of rats.
“I realised that understanding the brain circuitry controlling hot flushes could be useful for designing new treatments, but I never imagined that it would happen during my life,” said Rance, of the University of Arizona. “I was thrilled to learn about the FDA approval, in part because it illustrates how basic science research can lead to clinical applications.”
Rance's finding led to a study at Imperial College London, directed by Dhillo, which showed that a substance related to fezolinetant was particularly successful at preventing hot flashes in females.
“From our grant being awarded by NIHR [the National Institute for Health and Care Research] and MRC [the Medical Research Council], within two years we could show it had a 73 per centreduction in hot flashes – that wouldn’t have happened without taxpayers’ funding of medical research,” Dhillo said adding, "Since doing our studies, we’ve had women all over the world writing to us saying: ‘How can I get this drug?’”
“There’s been this attitude that obesity kills, heart disease kills, diabetes kills, women’s health doesn’t kill. We can’t be in Western society and say 51 per centof the population’s problems – if they don’t kill them immediately – aren’t important," he added.
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