Veozah: Pharmaceutical Gamechanger or Gimmick?

While recently enjoying an afternoon of Sunday football, I found myself perplexed by a commercial for Veozah, a trending, new prescription medicine that reduces moderate to severe menopause-related vasomotor symptoms (i.e. hot flashes and night sweats). Yes, it was somewhat odd to see the NFL sponsored by a menopause treatment, but that’s not what raised an eyebrow. Rather, it was their bold marketing of “100% hormone-free” that gave me pause.

Questionable Motives

My first thought was, why would they lean into hormone-free as a differentiator? The majority of medicines are hormone-free and don’t market themselves as such, so are they playing into pre-existing hormone therapy fears as a marketing tactic? As scientific researchers of women’s health, they must know hormone optimization has been proven safe and reduces the risk of several chronic diseases. I also found myself wondering why drug companies are developing new drugs to treat the individual symptoms of menopause when Bioidentical Hormone Replacement Therapy addresses the root cause of all symptoms. My guess: it has something to do with dollar signs.

Manufacturer Astellas boasts it will reap $2.2 billion a year by giving women a hormone therapy alternative and say this will significantly increase their company profits. The treatment, which is covered by some private insurance companies but not Medicare or Medicaid,  costs $550 per month, $6,600 annually, making it inaccessible for the majority of women. On the flip side, bioidentical hormones can easily be made in various forms by a compounding pharmacy for less than $50 per month. 

Astellas’ financial forecast paired with Veozah’s publicity machine, investment in a :30 second Super Bowl ad, and aggressive digital buy pushing the “hormone-free'' narrative leads me to believe this is a pharmaceutical strategy to make a lot of money. How? By using subliminal marketing to reinforce HRT’s stigma and steer women towards their new profit booster. 

Ryan Lester, PA-C, Wellcore’s resident hormone expert, shares my perspective saying, “Yes, it is likely a strategy to take advantage of the misinformation regarding the safety of hormone replacement therapy (HRT) that will result in massive financial gains for the pharmaceutical manufacturer and its shareholders. This medication is being positioned as a potentially safer alternative to HRT even though the alleged risks of HRT are not supported by evidence, lack clinical significance, and/or fail to outweigh the benefits to health and quality of life.

How Does Veozah Work?

Before a woman enters menopause, a balance exists between estrogen and a brain chemical called neurokinin B (NKB), that works to regulate body temperature. During menopause, estrogen levels decline and this balance is disrupted as NKB continues to activate the NK3 receptor, leading to vasomotor symptoms. Vasomotor symptoms are intense feelings of heat ("hot flashes"), night sweats, and feelings of warmth in the face, neck, and chest that can occur frequently in women transitioning through menopause. 

Veozah contains a drug called Fezolinetant. Fezolinetant is a neurokinin 3 (NK3) receptor antagonist that works to reduce the frequency and intensity of hot flashes by restoring the balance between estrogen and NKB by blocking NKB in the temperature control center of the brain.

BHRT vs. Veozah

So, why opt for a non-hormonal medication over BHRT? Lester says, Veozah provides an option for women unable to take estrogen replacement due to specific medical conditions, which are rare. It might appeal to women with a history of cancer or blood clots, where the risks of estradiol use could outweigh the benefits. 

The disadvantages? There’s no evidence to suggest that Veozah provides relief from other symptoms of menopause such as vaginal dryness or that it provides long term protection from chronic diseases. It also only addresses one of the many symptoms of menopause - vasomotor symptoms. 

The most common form of bioidentical estrogen used today is estradiol which eliminates hot flashes and night sweats, as well as reduces the risk of cardiovascular disease - the leading cause of death in women, Alzheimer’s disease, dementia, colon cancer, vaginal atrophy, urinary tract infections, macular degeneration, and cataracts. Most menopausal women should also start progesterone with estradiol, which has been shown to improve sleep disturbances, anxiety, depression, and reduce the risk of breast cancer, uterine cancer, and ovarian cancer. In comparison, Veozah is by far an inadequate treatment that only provides reprieve from two of the thirty-four symptoms associated with menopause.

A Question of Safety

When it comes to safety, BHRT’s safety and efficacy is supported by over 50 years of clinical studies. In contrast, Veozah's safety is limited to short-term studies conducted over the course of a year or less, leaving its long-term safety profile in question. And although Lester didn’t see any red flags with Veozah’s short term safety profile, he does mention it is contraindicated in those with liver cirrhosis, severe kidney disease, and anyone taking CYP1A2 inhibitors used to treat mental health issues such as Duloxetine, Allopurinol, Amiodarone, Famotidine and Cimetidine.

Dr. Stephanie Faubion, medical director for the North American Menopause Society and a director of the Mayo Clinic Center for Women’s Health gives her take in a recent New York Times article, saying “There are still a lot of unknowns about the drug, particularly any effects on heart health, bone health, sexual health, mood symptoms or weight. That is difficult to gauge fully until the drug is on the market and used by more people for longer durations. Only estrogen has been shown to provide other long-term health benefits beyond mitigating hot flashes.”

As for side effects, clinical studies suggest they are mild and easily managed, the most common being dry mouth, nausea, and liver enzyme elevation. Due to the latter side effect, Veozah requires liver enzyme monitoring every three months for the first year.

Should I Or Shouldn’t I?

For women weighing their treatment options, Lester says, “Speak to as many clinicians specializing in menopausal symptom treatments as you can and ask in depth questions to determine which option will work best for you. Ultimately, the question is what treatments will provide the most benefits with the lowest risk. It is also important to consider the long term risk of avoiding bioidentical hormone replacement as one ages.”

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