TOPLINE:

Elinzanetant, a dual neurokinin-targeted therapy, significantly reduced the frequency and severity of moderate-to-severe vasomotor symptoms or hot flushes and improved sleep disturbances associated with menopause, with superior or comparable efficacy to other non-hormonal treatments.

METHODOLOGY:

• Researchers conducted a network meta-analysis informed by a systematic literature review to indirectly compare the efficacy of elinzanetant with that of other non-hormonal treatments in the absence of head-to-head trials to evaluate the reduction in moderate-to-severe hot flushes and sleep disturbances in menopausal women.
• They performed literature search across multiple electronic databases and included 17 placebo-controlled randomised controlled trials comparing elinzanetant 120 mg with non-hormonal treatments (fezolinetant 45 mg, gabapentin 1200-1800 mg, paroxetine 7.5 mg, and desvenlafaxine 50-200 mg).
• Outcomes assessed at 12 weeks included changes in the frequency and severity of moderate-to-severe hot flushes, the proportion of women achieving at least a 50% reduction in the frequency of hot flushes, nighttime awakenings, and sleep disturbances.

TAKEAWAY:

• Elinzanetant significantly reduced the frequency of daily hot flushes than paroxetine 7.5 mg (mean difference [MD], -2.11; 95% credible interval [CrI], -3.31 to -0.92), desvenlafaxine at all doses (MD, -1.72 to -2.77), and gabapentin at all doses (MD, -2.22 to -2.31), with comparable efficacy to fezolinetant 45 mg.
• Elinzanetant was associated with higher odds of achieving at least a 50% reduction in the frequency of hot flushes than desvenlafaxine 100 mg (odds ratio [OR], 1.52; 95% CrI, 1.03-2.24) and paroxetine 7.5 mg (OR, 2.20; 95% CrI, 1.49-3.28), with comparable results to desvenlafaxine 150 mg and fezolinetant 45 mg.
• The reduction in the severity of hot flushes was significantly greater with elinzanetant than with desvenlafaxine 50 mg (MD, -0.37; 95% CrI, -0.56 to -0.17), with comparable efficacy to other desvenlafaxine doses (100, 150, and 200 mg), gabapentin (1200 and 1800 mg), and fezolinetant 45 mg.
• Nighttime awakenings were significantly reduced with elinzanetant than with paroxetine 7.5 mg (MD, -0.72; 95% CrI, -1.08 to -0.36) and all desvenlafaxine doses (MD, -0.51 to -0.97); sleep disturbances improved more with elinzanetant than with fezolinetant 45 mg (MD, -2.67; 95% CrI, -3.92 to -1.42).

IN PRACTICE:

"[The study] findings suggest that elinzanetant may offer a promising therapeutic option for women seeking relief from VMS [vasomotor symptoms] and sleep disturbances due to menopause, including those who cannot or do not wish to use hormonal treatments," the authors wrote.

SOURCE:

This study was led by Piotr Wojciechowski, Clever-Access, Kraków, Poland. It was published online on March 15, 2026, in BJOG: An International Journal of Obstetrics & Gynaecology.

LIMITATIONS:

This meta-analysis excluded studies assessing oxybutynin, clonidine, pregabalin, and certain antidepressants. Findings were based on indirect comparisons of trials rather than direct head‑to‑head comparisons. Safety outcomes were not assessed due to differing adverse event profiles, short trial durations, and limited number of adverse events.

DISCLOSURES:

This study received funding from Bayer. Two authors reported being employees of Bayer, and four declared being employees of Clever‑Access. Some authors declared receiving consulting fees, honoraria for teaching sessions/lectures, and support for attending meetings and participating in advisory boards of various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.