Episode Overview

Podcast: Dr. Chapa’s OBGYN Clinical Pearls
Episode: “Expression of Concern” Over a Green Journal Article
Date: January 24, 2026
Theme:
Dr. Chapa addresses a recent “Expression of Concern” issued by the editors of the Green Journal (Obstetrics & Gynecology, ACOG’s flagship publication) regarding a March 2025 published systematic review and meta-analysis. The study in question compared two non-hormonal medications for relief of moderate to severe hot flashes––fezolinitant (Veoza) and elinzanetant (Linquate). Dr. Chapa explains the implications, possible retraction, and what this means (and doesn’t mean) for clinical practice. The episode is also peppered with practical teaching and a “no spin” approach to education for clinicians.

Key Discussion Points & Insights

Background and Context

• Systematic Review & Meta-Analysis (March 2025):
  • Compared fezolinitant and elinzanetant (both non-hormonal, FDA-approved for hot flashes).
  • Both medications found effective vs. placebo for relief of moderate/severe hot flashes.
  • Meta-analysis suggested elinzanetant may have broader vasomotor symptom relief and better sleep improvement.
• Expression of Concern (January 16, 2026):
  • Editors of the Green Journal published a letter noting concerns about data accuracy and interpretation.
  • Retraction is being considered; a final decision is pending.

Why Is This Unusual & Significant?

• Retractions are rare—haven’t occurred in decades
  • “[Retraction] is kind of a pain in the ass to retract something once it’s out because it actually is a lot of work… Haven’t printed a retraction in 20 years.”
    —Dr. Chapa, [03:23]
• Dr. Chapa emphasizes the purpose of sharing this is to keep listeners informed about breaking, sometimes confusing, developments in women’s health literature.

Mechanism and Clinical Role of Fezolinitant & Elinzanetant

• Both Are Neurokinin Antagonists
  • Target KNDy receptors (neural pathway for hot flashes).
  • Fezolinitant blocks NK3 (single receptor), elinzanetant blocks both NK1 and NK3 (dual receptor).
  • Both have independent FDA supporting data; efficacy shown in OASIS trial.
• Practical Take: These meds are valuable options for patients who can’t, or won’t, use hormonal therapy.

Importance of the Expression of Concern

• Not About Drug Safety or FDA Labels:

  • “This is not somehow a proponent of canceling these medications or their FDA label. Not at all.” —Dr. Chapa, [07:26]

• Editorial Statement (Read Aloud):

  “The editors of Obstetrics and Gynecology are publishing this editorial response of concern because questions have been raised about the data presented. As a result of these concerns, the editors requested additional information which revealed that the interpretation of the data may not be accurate…the editors are currently considering editorial action which may include correction, retraction, or retraction and replacement. The readers…will be updated when a decision has been made.” —From Green Journal’s editorial, [09:40]

• Unanswered Questions:

  • Dr. Chapa: “Now, I don’t know what that means. Maybe is it fezolinitant that’s a little bit better? Maybe they’re both comparable? Maybe it’s the same as placebo? I don’t know.” [09:10]
  • The expression of concern is about the reliability of the meta-analysis, not about the underlying drugs’ validity or safety.

Practical Pearls for Clinicians

• Monitoring: Both drugs can elevate liver enzymes—monitor at baseline and periodically.
• Shared Decision Making:
  • For patients averse to estrogen or with contraindications, non-hormonal options remain valid.
  • “I think these medications offer a nice option for those who have moderate to severe hot flashes but are afraid of estrogen use and or have a contraindication, as I’ve already stated.” —Dr. Chapa, [08:19]

Notable Quotes & Memorable Moments

• On Retracting Articles:

  • “There’s a time for everything…kind of is, excuse my French, kind of a pain in the ass to retract something once it’s out because it actually is a lot of work…”
    —Dr. Chapa, [03:23]

• On the Meaning of the Expression of Concern:

  • “This is not somehow a proponent of canceling these medications or their FDA label. Not at all. It’s a systematic review of meta analysis where the editors are saying, we’ve got, we’ve got an expression of concern here.”
    —Dr. Chapa, [07:26]

• On Clinical Use Despite Editorial Actions:

  • “Just to be fair, you know, the FDA is still sticking with the label. This is not about label change…I think in the appropriate patient who does not have elevated liver enzymes…these have a place.” —Dr. Chapa, [07:52]

• On What’s Next:

  • “We don’t know yet as of January 16, 2026, because the data is being examined again independently, because of expressions of concern, and we’ll leave it at that.” —Dr. Chapa, [10:38]

Timestamps for Key Segments

• Episode setup and context: [01:07]–[03:00]
• Background on the article and meds: [03:00]–[05:20]
• What is an ‘Expression of Concern’ and why it matters: [05:20]–[07:00]
• Mechanisms, effectiveness, and clinical reminders: [07:03]–[08:45]
• Reading and discussing the editorial statement: [09:40]–[10:38]
• Side note on hormone therapy in patients with thrombosis: [11:28]–[12:55]

Extra Pearl: Hormone Therapy & History of Thrombosis

• Dr. Chapa addresses a listener question:
  • New patient on transdermal estradiol and natural progesterone for hot flashes, but with prior arterial and venous thrombosis.
  • Traditional teaching: contraindicated. But new data (especially with transdermals) is challenging this stance; emphasizes the need for shared decision making.

“Traditionally a previous arterial or venous thrombosis was a contraindication of hormone therapy…I mean, it just is of all types. However, transdermal estradiol doesn’t go through the first pass effect and has almost nil effect on pro inflammatory markers and pro thrombotic factors. And there’s a lot of good data…that even in those patients, nothing really happened. So…in the middle is shared decision making.” —Dr. Chapa, [12:10]

Conclusion & Takeaways

• If you hear colleagues referencing the March 2025 meta-analysis, know that its validity is now in question pending further editorial review.
• No change in clinical use of fezolinitant or elinzanetant at this time; both remain valuable for hot flash relief in appropriate patients.
• Editorial actions—a correction, retraction, or replacement—await final determination by the Green Journal.
• Stay tuned for further updates to keep your counseling and prescribing evidence-based.