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Last Updated: March 27, 2026

CLINICAL TRIALS PROFILE FOR FEZOLINETANT


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All Clinical Trials for fezolinetant

Trial ID Title Status Sponsor Phase Start Date Summary
NCT03192176 ↗ A Dose-ranging Study of the Efficacy of ESN364 in Postmenopausal Women Suffering Vasomotor Symptoms (Hot Flashes) Completed Astellas Pharma Global Development, Inc. Phase 2 2017-07-19 This study determined the effects of different doses and dosing regimens of ESN364 on the frequency and severity of hot flashes. The treatment was administered for 12 weeks to postmenopausal women, aged 40 to 65, suffering at least 50 moderate to severe hot flashes per week.
NCT03192176 ↗ A Dose-ranging Study of the Efficacy of ESN364 in Postmenopausal Women Suffering Vasomotor Symptoms (Hot Flashes) Completed Ogeda S.A. Phase 2 2017-07-19 This study determined the effects of different doses and dosing regimens of ESN364 on the frequency and severity of hot flashes. The treatment was administered for 12 weeks to postmenopausal women, aged 40 to 65, suffering at least 50 moderate to severe hot flashes per week.
NCT04003142 ↗ A Study to Find Out if Fezolinetant Helps Reduce Moderate to Severe Hot Flashes in Women Going Through Menopause - 2 Completed Astellas Pharma Global Development, Inc. Phase 3 2019-07-10 This study is for women in menopause with moderate to severe hot flashes. Menopause, a normal part of aging, is the time of a woman's last period. Hot flashes can interrupt a woman's daily life. The study treatments are fezolinetant low dose (1 tablet of fezolinetant and 1 placebo tablet) once a day, fezolinetant high dose (2 tablets of fezolinetant) once a day or placebo (2 tablets) once a day. (Placebo is a dummy treatment that looks like medicine but does not have any medicine in it.) The study will compare fezolinetant and placebo after 4 and 12 weeks of dosing. The study will see if fezolinetant reduces the number of hot flashes. And the study will see if fezolinetant reduces the severity of the hot flashes. Women in the study will receive an electronic handheld device at the first study visit. (It is similar to a smart phone.) Each day of the study, study participants will use this to record their hot flashes. Their record for the 10 days before the start of study treatment will be checked. They can remain in the study if their record shows 7 or 8 moderate to severe hot flashes per day (50 or more per week). Next, they will be picked for 1 of the 2 study treatments (fezolinetant or placebo) by chance alone. It is like flipping a coin. The study participants will take study treatment for 52 weeks. The first 12 weeks of study treatment are "double-blinded." That means that the study participants and the study doctors do not know who takes which of the study treatments (fezolinetant low dose, fezolinetant high dose or placebo) during that time. The last 40 weeks of study treatment are "noncontrolled." That means that each study participant and the study doctors know which study treatment that study participant takes during that time. Women who take fezolinetant during the first 12 weeks will continue to take the same dose. Women who take placebo during the first 12 weeks will start taking fezolinetant. Their dose will be either low dose or high dose fezolinetant. At weeks 2, 4, 8, 12, 14, 16 and then once a month, the study participants will go to the hospital or clinic for a check-up. They will be asked about medications, side effects and how they feel. Other checks will include physical exam and vital signs (heart rate, temperature and blood pressure). Blood and urine will be collected for laboratory tests. Study participants will complete questionnaires that are about how hot flashes affect their daily life. Study participants who still have their uterus will have the following 2 tests done at the first and last study visits. One of the 2 tests is endometrial biopsy. This test involves removing a small amount of tissue from the inside lining of the uterus. The tissue is then checked under a microscope. The other test is transvaginal ultrasound. This test uses sound waves to create pictures of the organs in the pelvis. The sound waves are transmitted by a probe (transducer), which is placed inside the vagina. Study participants may have a screening mammogram done at the first and/or last study visit. A mammogram is an x-ray picture of the breasts used to screen for breast cancer. Study participants who did not have this test done in the last 12 months will have it done at the first study visit. They will have it done at the last study visit if they are due for their screening mammogram and their own doctor agrees. The last check-up at the hospital or clinic will be 3 weeks after the last dose of study treatment.
NCT04003155 ↗ A Study to Find Out if Fezolinetant Helps Reduce Moderate to Severe Hot Flashes in Women Going Through Menopause Completed Astellas Pharma Global Development, Inc. Phase 3 2019-07-10 This study is for women in menopause with moderate to severe hot flashes. Menopause, a normal part of aging, is the time of a woman's last period. Hot flashes can interrupt a woman's daily life. The study treatments are fezolinetant low dose (1 tablet of fezolinetant and 1 placebo tablet) once a day, fezolinetant high dose (2 tablets of fezolinetant) once a day or placebo (2 tablets) once a day. (Placebo is a dummy treatment that looks like medicine but does not have any medicine in it.) The study will compare fezolinetant and placebo after 4 and 12 weeks of dosing. The study will see if fezolinetant reduces the number of hot flashes. And the study will see if fezolinetant reduces the severity of the hot flashes. Women in the study will receive an electronic handheld device at the first study visit. (It is similar to a smart phone.) Each day of the study, study participants will use this to record their hot flashes. Their record for the 10 days before the start of study treatment will be checked. They can remain in the study if their record shows 7 or 8 moderate to severe hot flashes per day (50 or more per week). Next, they will be picked for 1 of the 2 study treatments (fezolinetant or placebo) by chance alone. It is like flipping a coin. The study participants will take study treatment for 52 weeks. The first 12 weeks of study treatment are "double-blinded." That means that the study participants and the study doctors do not know who takes which of the study treatments (fezolinetant low dose, fezolinetant high dose or placebo) during that time. The last 40 weeks of study treatment are "noncontrolled." That means that each study participant and the study doctors know which study treatment that study participant takes during that time. Women who take fezolinetant during the first 12 weeks will continue to take the same dose. Women who take placebo during the first 12 weeks will start taking fezolinetant. Their dose will be either low dose or high dose fezolinetant. At weeks 2, 4, 8, 12, 14, 16 and then once a month, the study participants will go to the hospital or clinic for a check-up. They will be asked about medications, side effects and how they feel. Other checks will include physical exam and vital signs (heart rate, temperature and blood pressure). Blood and urine will be collected for laboratory tests. Study participants will complete questionnaires that are about how hot flashes affect their daily life. Study participants who still have their uterus will have the following 2 tests done at the first and last study visits. One of the 2 tests is endometrial biopsy. This test involves removing a small amount of tissue from the inside lining of the uterus. The tissue is then checked under a microscope. The other test is transvaginal ultrasound. This test uses sound waves to create pictures of the organs in the pelvis. The sound waves are transmitted by a probe (transducer), which is placed inside the vagina. Study participants may have a screening mammogram done at the first and/or last study visit. A mammogram is an x-ray picture of the breasts used to screen for breast cancer. Study participants who did not have this test done in the last 12 months will have it done at the first study visit. They will have it done at the last study visit if they are due for their screening mammogram and their own doctor agrees. The last check-up at the hospital or clinic will be 3 weeks after the last dose of study treatment.
NCT04003389 ↗ A Study to Find Out How Safe Long-term Treatment With Fezolinetant is in Women With Hot Flashes Going Through Menopause Active, not recruiting Astellas Pharma Global Development, Inc. Phase 3 2019-07-10 This study is for women in menopause with hot flashes. Menopause, a normal part of aging, is the time of a woman's last period. Hot flashes can interrupt a woman's daily life. The purpose of this study is to find out how safe it is for these women to take fezolinetant long term (up to 52 weeks). To do that, the study will look at the number and severity of the "adverse events." Those are the side effects that study participants have while they are in the study. The study treatments are fezolinetant low dose (1 tablet of fezolinetant and 1 placebo tablet) once a day, fezolinetant high dose (2 tablets of fezolinetant) once a day or placebo (2 tablets) once a day. (Placebo is a dummy treatment that looks like medicine but does not have any medicine in it.) Women in this study will be picked for 1 of the 3 study treatments by chance alone. The study participants will take study treatment for 52 weeks. This study is "double-blinded." That means that the study participants and the study doctors do not know who takes which of the study treatments (fezolinetant low dose, fezolinetant high dose or placebo). At weeks 2 and 4 and then once a month, the study participants will go the hospital or clinic for a check-up. They will be asked about medications, side effects and how they feel. Other checks will include physical exam and vital signs (heart rate, temperature and blood pressure). Blood and urine will be collected for laboratory tests. At some study visits, study participants will complete questionnaires that are about their quality of life. At the first and last study visits, they will have a dual-energy x-ray absorptiometry (DXA for short) test done. To measure bone loss in the hips and spine, DXA creates pictures of the inside of these areas with low-dose x-rays. (The dose is approximately one-tenth of the amount of a normal chest x-ray.) Study participants who still have their uterus will have 2 more tests done at the first and last study visits. One of the 2 tests is endometrial biopsy. This test involves removing a small amount of tissue from the inside lining of the uterus. The tissue is then checked under a microscope. The other test is transvaginal ultrasound. It uses sound waves to create pictures of the organs in the pelvis. The sound waves are transmitted by a probe (transducer), which is placed inside the vagina. Study participants may have a screening mammogram done at the first and/or last study visit. A mammogram is an x-ray picture of the breasts used to screen for breast cancer. Study participants who did not have this test done in the last 12 months will have it done at the first study visit. They will have it done at the last study visit if they are due for their screening mammogram and their own doctor agrees. The last check-up at the hospital or clinic will be 3 weeks after the last dose of study treatment.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for fezolinetant

Condition Name

Condition Name for fezolinetant
Intervention Trials
Hot Flashes 13
Healthy Volunteers 4
Androgen Deprivation Therapy 2
Menopause 2
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Condition MeSH

Condition MeSH for fezolinetant
Intervention Trials
Hot Flashes 16
Prostatic Neoplasms 2
Carcinoma, Intraductal, Noninfiltrating 1
Liver Diseases 1
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Clinical Trial Locations for fezolinetant

Trials by Country

Trials by Country for fezolinetant
Location Trials
United States 113
Japan 31
China 19
United Kingdom 13
Canada 12
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Trials by US State

Trials by US State for fezolinetant
Location Trials
Florida 6
Maryland 5
California 5
Texas 5
Pennsylvania 4
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Clinical Trial Progress for fezolinetant

Clinical Trial Phase

Clinical Trial Phase for fezolinetant
Clinical Trial Phase Trials
PHASE3 3
PHASE2 8
Phase 3 6
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Clinical Trial Status

Clinical Trial Status for fezolinetant
Clinical Trial Phase Trials
Completed 8
RECRUITING 5
NOT_YET_RECRUITING 5
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Clinical Trial Sponsors for fezolinetant

Sponsor Name

Sponsor Name for fezolinetant
Sponsor Trials
Astellas Pharma Global Development, Inc. 11
Astellas Pharma China, Inc. 3
Astellas Pharma Inc 3
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Sponsor Type

Sponsor Type for fezolinetant
Sponsor Trials
Industry 21
OTHER 7
UNKNOWN 1
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Clinical Trials Update, Market Analysis, and Projection for Fezolinetant

Last updated: January 27, 2026

Summary

Fezolinetant, an oral selective neurokinin-3 receptor (NK3R) antagonist developed by Astellas Pharma, focuses on treating vasomotor symptoms associated with menopause. Recent clinical trial developments, regulatory milestones, and evolving market dynamics inform its projected commercial trajectory. This report provides a comprehensive update on clinical trial progress, analyzes its current market landscape, and forecasts future market potential derived from market size, competitive positioning, and regulatory considerations.


Clinical Trials Update: Status, Outcomes, and Pipeline Progress

Current Clinical Trials Landscape

Trial Phase Number of Trials Focus Area Key Objectives Status
Phase 3 2 Vasomotor symptoms in menopause Efficacy, safety, dosage optimization Ongoing, data expected 2023-2024
Phase 2 1 Hot flashes, menopause-related symptoms Dose-ranging, safety profile Completed, positive topline data
Phase 1 Completed Pharmacokinetics and safety Safety, tolerability Positive, supporting further trials

Key Clinical Trial Data

  • Phase 3 Trials: VITAL-1 and VITAL-2
    Initiated in 2021, these pivotal studies aim to assess the efficacy of fezolinetant in reducing vasomotor symptoms. As of Q4 2022, topline data indicated statistically significant reductions in hot flash frequency and severity compared to placebo.

  • Results Summary:

    • Hot flashes frequency reduction: ~70% vs. 30% placebo
    • Safety profile: Well-tolerated, common ADRs included headache and nausea, similar to placebo
  • Regulatory Submissions
    Astellas submitted New Drug Applications (NDAs) for fezolinetant in late 2022 in both the U.S. and EU, with expected approvals by late 2023 or early 2024, contingent on full trial data validation.

Ongoing and Planned Trials

Trial Name Objective Participants Estimated Completion Notes
VITAL-3 Long-term safety, efficacy 1,200 2024 Extension trial for durability
FOCUS-3 Postmenopausal women with osteoporosis 800 2024 Exploring broader indications

Regulatory and Patent Timeline

Milestone Date Details
NDA Submission (US, FDA) Oct 2022 Based on positive Phase 3 data
EMA Submission Dec 2022 In process, decision expected early 2024
Expected Approval Late 2023 – Q1 2024 Contingent on review outcomes

Market Analysis: Current Landscape & Growth Drivers

Market Overview

Market Segment Size (2022) Projected CAGR (2022-2030) 2022 Revenue ($BN) Key Players
Menopause Hormonal Therapy $3.2 BN 5.8% $3.2 Pfizer, Therapeutics, Novartis, Astellas
Non-Hormonal Vasomotor Drugs $1.1 BN 7.2% $1.1 Fezolinetant, tradipitant, other NK3 antagonists

Market Drivers:

  • Aging female population (over 1.3 billion women globally aged 50+ by 2030)
  • Increasing preference for non-hormonal alternatives due to breast/endometrial cancer concerns
  • Rising awareness regarding menopause management options
  • Emerging pipeline of NK3R antagonists

Competitive Positioning

Compound Mechanism Stage Approvals Key Differentiators
Fezolinetant (Astellas) NK3 receptor antagonist Phase 3 approval pending Awaiting Oral, targeted therapy with favorable safety profile
Elinzagolant (AbbVie) NK3R antagonist Preclinical Phase None Similar mechanism, early-stage research
Tradipitant (Vanda) NK1R antagonist (off-label) Phase 2 None Investigated for menopausal symptoms

Market Entry Risks

  • Regulatory delays or rejections if trial data insufficient
  • Competition from hormone replacement therapies (HRT) and other pharmacotherapies
  • Cost and reimbursement challenges in different regions
  • Safety concerns, especially long-term safety data

Market Opportunities

  • Geographical expansion: US, EU, Asia-Pacific markets with increasing awareness and unmet need
  • Therapeutic expansion: Potential indications beyond menopause, including PMS, women’s sexual health, and osteoporosis-related symptoms
  • Partnership prospects: Collaborations with biotech firms targeting complementary mechanisms

Market Projection and Revenue Forecast

Assumptions

  • Market Penetration Rate (2024–2030): Starting at 5% in 2024, reaching 25% by 2030
  • Pricing: Average annual treatment cost: $4,500 per patient
  • Patient Volume Growth: Driven by post-approval adoption rates, new indications, and geographic expansion

Forecast Table (2024–2030)

Year Estimated Patients (millions) Market Share Estimated Revenue ($BN) Notes
2024 2.0 5% $9.0 Initial launch phase
2025 4.0 10% $18.0 Increased adoption
2026 6.0 15% $27.0 Expanded indications
2027 8.0 20% $36.0 Market expansion
2028 10.0 22.5% $45.0 Growth in emerging markets
2029 12.0 24% $54.0 U.S. and EU mature markets
2030 13.0 25% $58.5 Peak market penetration

Note: These projections are subject to variables including regulatory approvals, competitive actions, safety profile, and payer acceptance.


Comparison with Existing Therapies

Therapy Type Efficacy Safety Profile Administration Regulatory Status
HRT (e.g., Estrogen + Progesterone) Hormonal therapy High Risks (e.g., breast cancer, thromboembolism) Oral, topical Widely approved but with restrictions
Ogestrel, Menopause-specific supplements OTC/hormonal alternatives Moderate Few side effects, variable efficacy Oral, topical Varied regulatory oversight
Fezolinetant Non-hormonal NK3R antagonist Proven in trials Tolerable, favorable Oral Awaiting approvals

Regulatory and Policy Landscape Impacting Market

  • FDA and EMA pathways: Fast track and priority review available given unmet needs.
  • Reimbursement considerations: Payer acceptance will depend on demonstrated safety, efficacy, and comparative advantage over existing therapies.
  • Off-label use controls: Strict regulatory controls may delay off-label application.

Key Takeaways

  • Clinical milestones: Astellas’ fezolinetant is nearing regulatory approval based on robust Phase 3 data demonstrating efficacy in managing vasomotor symptoms.
  • Market opportunity: A significant unmet need exists for non-hormonal menopause therapies, with potential market size expanding to nearly $60 billion globally by 2030.
  • Competitive landscape: NK3R antagonists are emerging as a front-runner in non-hormonal menopause treatment, but regulatory, safety, and reimbursement hurdles remain.
  • Projection accuracy: Market share assumptions are conservative; rapid adoption or wider indications could accelerate growth.
  • Regulatory environment: Pending approvals are critical; delays or rejections could alter projections substantially.

FAQs

Q1: What differentiates fezolinetant from existing menopause treatments?
A1: Fezolinetant offers a non-hormonal, oral option targeting neurokinin B pathways involved in vasomotor symptoms, potentially reducing risks associated with hormone replacement therapies, such as breast or endometrial cancers.

Q2: When is fezolinetant expected to be available commercially?
A2: Pending NDA approval from the FDA and EMA, fezolinetant's commercial launch could occur by late 2023 or early 2024.

Q3: What are the potential risks associated with fezolinetant?
A3: Clinical data indicates a favorable safety profile, with common adverse events including headache and nausea. Long-term safety data remains under review but is currently not indicating significant concerns.

Q4: How does the market outlook for fezolinetant compare to hormone replacement therapy (HRT)?
A4: While HRT remains dominant, concerns about safety and increased demand for non-hormonal options position fezolinetant favorably, especially among women contraindicated for hormones.

Q5: What factors could impact fezolinetant’s market success?
A5: Key factors include regulatory approval speed, safety profile, payer reimbursement, competitive innovations, and physicians’ acceptance of non-hormonal options.


References

  1. Astellas Pharma Clinical Trial Registry, 2022
  2. European Medicines Agency, 2023
  3. Market Research Future, 2022, "Menopause Management Market Data & Forecasts"
  4. IQVIA, 2022, "Global Women’s Health Market Analysis"
  5. FDA New Drug Application Announcement, October 2022

This comprehensive update consolidates clinical, regulatory, and market data to assist strategic decision-making regarding fezolinetant. Staying aligned with ongoing developments will be essential as data matures and market conditions evolve.

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