Podcast Summary: "New Med For Hot Flashes"

Dr. Chapa’s OBGYN Clinical Pearls
Date: October 29, 2025
Host: Dr. Chapa

Main Theme

This episode spotlights the newly FDA-approved medication for menopausal hot flashes: Linket (generic: elinzanetant), explains its mechanism, clinical trial data, differences from existing options like Fezolinetant (Veoza), and touches on ongoing research into other hormone therapies. Dr. Chapa maintains his energetic, relatable style throughout, aiming to empower listeners with practical, evidence-based clinical pearls.

Key Discussion Points & Insights

1. Humor and Empathy: Opening Remarks on Hot Flashes

• Dr. Chapa uses humor to illustrate hot flashes and empathizes with the discomfort women experience, contrasting it with the stereotypical “man cold.”
  • Quote: “If men suffered from hot flashes, we would all be screwed.” (01:24)
• Contextualizes hot flashes as a major quality-of-life issue for women.

2. Existing Treatments and Their Limitations

• Estrogen Therapy:
  • Still considered highly effective but controversial due to outdated black box warnings from the WHI trial.
  • Quote: “The black box warning on traditional HRT needs to go away because that’s all bad science stuff from a jacked-up trial called WHI...” (02:30)
• Fezolinetant (Veoza):
  • Discussed as a recent non-hormonal oral therapy for hot flashes.
  • Downside: high cost, need for liver monitoring, and not always suitable for all.

3. Introducing Linket (Elinzanetant): The New Kid on the Block

• FDA Approval:
  • Approved on October 24, 2025 by Bayer.
  • Quote: “Brand new medication that just got FDA approved on October 24, 2025... non-branded name is ellenzanetant. The brand name is Linket.” (04:00)
• Mechanism of Action:
  • “First and only dual neurokinin therapy” – blocks both Neurokinin 1 and 3 receptors.
  • Compared to Veoza (which blocks only NK3), Linket acts on more “switches” in the brain’s “candy” (KNDY) neuron system for regulating vasomotor symptoms.
  • Quote: “While Veoza only hits on one of the channels, this one knocks out two.” (11:19)
• Key distinction:
  • Linket is NOT an estrogen or hormone therapy, so may be safer for populations like breast cancer survivors.

4. Side Note: The Natural Estrogen—Estetrol (E4)

• Estetrol/E4:
  • Occurs naturally and used in certain birth controls (Nextellis).
  • Under study for vasomotor symptom relief (E4 Comfort-1 and Comfort-2 trials).
  • Not the main focus, but Dr. Chapa highlights its relevance as a potential “safer” estrogen option.
  • Quote: “That’s the new estrogen, it’s natural, that has four groups versus estradiol, which has two... Get it? E4 estetrol” (07:30)

5. Comparing Linket and Veoza: Mechanism and Effectiveness

• Neurokinin Antagonists:
  • Veoza: Selective NK3 receptor antagonist.
  • Linket: Dual NK1 and NK3 antagonist—i.e., blocks more of the brain’s “hot flash switches.”
  • Quote: “So the new medication is a Neurokinin 1 and 3 blocker, whereas Veoza only hits Neurokinin 3.” (13:18)
• Clinical Impact:
  • Linket offers:
    • Faster onset of hot flash relief than Veoza.
    • Greater improvement in sleep quality (a significant differentiator).
    • Based on meta-analyses and phase 3 trial data (OASIS-1 & OASIS-2).
  • Quote: “This new medication seems to affect hot flash reduction just as good as Veoza, with the added advantage [that] this tends to improve sleep as well.” (15:45)

6. OASIS-1 and OASIS-2 Trials

• Design:

  • Multicenter, double-blind, phase 3 RCTs.
  • Women aged 40-65, moderate-to-severe vasomotor symptoms.
  • Intervention: Elinzanetant 120 mg daily vs. placebo.
  • Diverse international sites (U.S., Europe, Israel, Canada).

• Main Outcomes:

  • Both Linket and Veoza worked, but Linket outperformed on sleep quality and speed of symptom relief.
  • Quote:
    • “Elinzanetant 120mg showed a significant improvement in sleep quality.” (18:50)
    • “Elinzanetant provided a larger effect size in vasomotor symptom frequency and severity reduction and greatly improved sleep quality compared with fezolinetant.” (18:50)

7. Side Effects and Monitoring

• Linket Side Effects:
  • Headache and fatigue noted as more frequent, but may improve with time.
  • Quote: “Headache was one of the big issues here.” (20:00)
• Liver Monitoring:
  • Required for both Veoza and Linket, despite Linket possibly being friendlier to the liver.

8. Use in Special Populations: Breast Cancer Survivors

• Reassuring Data:
  • Linket reduced hot flash severity even among women with breast cancer (unable to use estrogens) per New England Journal of Medicine data.
  • Quote: “Linked seemed to reduce hot flash severity even in these high-risk patients, and that is very, very reassuring.” (22:10)

9. Cost and Commercial Availability

• Cost:
  • Unknown, but expected to be expensive.
  • Commercial Availability:
    • FDA approved, but may not yet be on all markets.

10. Dr. Chapa’s Closing Thoughts and Tone

• Stresses this is for awareness, not promotion; neither Bayer/Veoza sponsor the podcast.
• Emphasizes gratitude for listeners and commitment to practical education.

Notable Quotes & Moments (with Timestamps)

• “If men suffered from hot flashes, we would all be screwed.” – Dr. Chapa (01:24)
• “The black box warning on traditional HRT needs to go away because that’s all bad science stuff from a jacked-up trial called WHI.” (02:30)
• “Brand new medication that just got FDA approved on October 24, 2025... non-branded name is ellenzanetant. The brand name is Linket.” (04:00)
• “So the new medication is a Neurokinin 1 and 3 blocker, whereas Veoza only hits Neurokinin 3.” (13:18)
• “Elinzanetant provided a larger effect size in vasomotor symptom frequency and severity reduction and greatly improved sleep quality compared with fezolinetant.” (18:50)
• “Linked seemed to reduce hot flash severity even in these high-risk patients, and that is very, very reassuring.” (22:10)

Timestamps for Key Segments

• 00:08–02:30: Humorous opening; empathy for hot flash sufferers; context setting for episode’s theme.
• 02:31–04:30: Brief on estrogen therapy and Veoza; problems with hormone therapy perception.
• 04:31–07:30: Introduction of Linket and elinzanetant; early data and comparison to estetrol (E4).
• 07:31–10:00: Update on natural estrogens, E4 “Comfort” trials, and Nextellis birth control.
• 10:01–15:45: Mechanisms of neurokinin-related drugs; KNDY neuron system explained.
• 15:46–18:50: Clinical trial review (OASIS 1 & 2); efficacy and sleep benefits.
• 18:51–20:00: Side effects (headache, fatigue) and monitoring requirements.
• 20:01–22:10: Application in breast cancer survivors, data from New England Journal.
• 22:11–end: Wrap-up, commercial caveats, Dr. Chapa’s appreciation for the audience.

Takeaway Pearls

• Linket (elinzanetant) offers a new, non-hormonal option for hot flashes, showing quicker relief and better sleep than predecessor Veoza, but with similar need for liver monitoring and new side effect concerns (headache, fatigue).
• Strong evidence supports its relevance, especially for women who can’t take estrogens (e.g., breast cancer survivors).
• Natural estrogens like estetrol are under study and represent another direction for safer hormone therapy.
• Costs and true market availability of Linket are still unknown but expected to be high.

Dr. Chapa continues to make women’s health education engaging, practical, and approachable, grounding clinical advances in real-world relevance.