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Estetrol

Phase 3

Vasomotor Symptoms | Small molecule | Other |Icon Plc|Last Updated: Dec 26, 2025

Success Probability
Approval Probability 71%
TA Base Rate26%
Adjusted LOA41%
ML RiskLOW_RISK
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Market & Valuation
rNPV $3.2B
Market Size $9.4B
Revenue Basis $1.6B
Competitors 6
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Trial Design
RandomizedDouble-BlindPLACEBO_CONTROLLEDDMCBiomarker
Total Trials2
Total Enrollment2,585
FDA Designations
No designations recorded
Clinical Trials (2)
NCT IDTitlePhaseStatusEnrollmentVelocityDesignStartCompletionLast UpdatedSitesCountries
NCT04209543Estetrol for the Treatment of Moderate to Severe Vasomotor Symptoms in Postmenopausal Women (E4Comfort Study I)PHASE3 COMPLETED 1,570Dec 30, 2019Feb 8, 2024Jan 29, 2025224 United States, Argentina +12
NCT04090957Estetrol for the Treatment of Moderate to Severe Vasomotor Symptoms in Postmenopausal Women (E4Comfort II)PHASE3 COMPLETED 1,015Sep 27, 2019Aug 18, 2022Dec 26, 2025117 United States, Canada
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Study Endpoints
Primary Endpoints
Mean change in weekly frequency of moderate to severe vasomotor symptoms (VMS) from Baseline to Week 4 (Efficacy Study Part)
Baseline and Week 4

The weekly frequency of moderate to severe VMS at Baseline and Week 4 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 4. Mean change = mean weekly frequency at Week 4 - mean weekly frequency at Baseline

Mean change in weekly frequency of moderate to severe vasomotor symptoms (VMS) from Baseline to Week 12 (Efficacy Study Part)
Baseline and Week 12

The weekly frequency of moderate to severe VMS at Baseline and Week 12 is defined as the total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization for Baseline and at Week 12. Mean change = mean weekly frequency at Week 12 - mean weekly frequency at Baseline

Mean change in severity of moderate to severe vasomotor symptoms (VMS) from Baseline to Week 4 (Efficacy Study Part)
Baseline and Week 4

The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 4 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 4. Baseline and Week 4 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 4 - mean severity score at Baseline

Mean change in severity of moderate to severe vasomotor symptoms (VMS) from Baseline to Week 12 (Efficacy Study Part)
Baseline and Week 12

The severity score is derived as follows: mild = 1, moderate = 2, and severe = 3. The mean severity score of VMS at Baseline and Week 12 is defined as the arithmetic mean of the daily severity score values of moderate and severe VMS observed from the last 7 days prior randomization for Baseline and of moderate and severe VMS observed at Week 12. Baseline and Week 12 severity score = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/ (total number of moderate + severe VMS). Mean change = mean severity score at Week 12 - mean severity score at Baseline

Incidence of endometrial hyperplasia with up to 12 months of treatment based on endometrial biopsies (Endometrial and General Safety Study Part)
Screening and Week 53

Endometrial biopsies will be centrally evaluated by three independent expert pathologists from different institutions, blinded to treatment group and to each other's readings. The concurrence of two of the three pathologists will be accepted as the final diagnosis. If there is no agreement among the three pathologists, the most severe pathologic diagnosis, i.e., atypical hyperplasia \>complex hyperplasia \>simple hyperplasia \>benign endometrium, will be used as the final diagnosis.

Mean Change in Weekly Frequency of Moderate to Severe Vasomotor Symptoms (VMS) From Baseline to Week 4 and Week 12 -- (Efficacy Study Part)
Week 0 (Baseline), Week 4, Week 12.

Weekly frequency of moderate to severe VMS at Baseline = total number (sum) of all recorded moderate to severe VMS experienced during the last 7 consecutive days prior randomization (Week 0). Weekly frequency of moderate to severe VMS at Week X = total number (sum) of all recorded moderate to severe VMS experienced during the week X.

Mean Change in Severity of Moderate to Severe Vasomotor Symptoms (VMS) From Baseline to Week 4 and Week 12 -- (Efficacy Study Part)
Week 0 (Baseline), Week 4, Week 12.

Mean severity score of VMS at Baseline: arithmetic mean of daily severity score values of moderate and severe VMS during the last 7 days prior randomization (Week 0). Mean severity score of VMS at Week 4 or 12: arithmetic mean of daily severity score values of moderate and severe VMS during Week 4 or 12. Daily severity score of VMS at Baseline = \[(2 x number of moderate VMS) + (3 x number of severe VMS)\]/(total number of moderate + severe VMS)\], if at least one moderate to severe VMS was recorded during the day. If documented absence of moderate to severe VMS during the day, daily severity was set to zero. Daily severity score of VMS Post-Baseline = \[(1 x number of mild VMS) + (2 x number of moderate VMS) + (3 x number of severe VMS)\]/(total number of mild + moderate + severe VMS)\], if at least one mild to severe VMS was recorded during the day. If documented absence of VMS during the day, daily severity was set to zero. Severity score: mild=1, moderate=2, severe=3.

Secondary Endpoints
Mean change from Baseline to Week 1 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) (Efficacy Study Part)
Baseline and Week 1
Mean change from Baseline to Week 2 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) (Efficacy Study Part)
Baseline and Week 2
Mean change from Baseline to Week 3 in the weekly frequency and severity of moderate to severe vasomotor symptoms (VMS) ((Efficacy Study Part)
Baseline and Week 3
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Study Design & Arms
AllocationRANDOMIZED
MaskingQUADRUPLE
ModelPARALLEL
PurposeTREATMENT
Treatment Arms
ArmTypeDescription
Estetrol 15 mg - Efficacy PartEXPERIMENTALEstetrol (E4) 15 mg was administered orally once daily for a minimum of 12 weeks and not longer than 13 weeks.
Estetrol 20 mg - Efficacy PartEXPERIMENTALEstetrol (E4) 20 mg was administered orally once daily for a minimum of 12 weeks and not longer than 13 weeks.
Placebo - Efficacy PartPLACEBO_COMPARATORPlacebo was administered orally once daily for a minimum of 12 weeks and not longer than 13 weeks.
Estetrol 20 mg + P4 100 mg - Safety PartEXPERIMENTALEstetrol (E4) 20 mg and Progesterone (P4) 100 mg was administered once daily for up to 53 weeks.
Estetrol 15 mg - Efficacy Study PartEXPERIMENTALEstetrol (E4) 15 mg, administered orally once daily for up to 53 weeks.
Estetrol 20 mg - Efficacy Study PartEXPERIMENTALEstetrol (E4) 20 mg, administered orally once daily for up to 53 weeks.
Placebo - Efficacy Study PartPLACEBO_COMPARATORPlacebo, administered orally once daily for up to 53 weeks.
Estetrol 20 mg - Safety Study PartEXPERIMENTALEstetrol (E4) 20 mg, administered orally once daily for up to 53 weeks.
Interventions
NameTypeDescription
EstetrolDRUGEstetrol oral tablet: administered orally once daily
PlaceboDRUGPlacebo oral tablet: administered orally once daily
ProgesteroneDRUGProgesterone oral tablet: administered orally once daily
Estetrol oral tabletDRUGEstetrol oral tablet, administered orally once daily.
Placebo oral tabletDRUGPlacebo oral tablet, administered orally once daily.
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Eligibility Criteria
Age Range40 Years — 65 Years
SexFEMALE
Healthy VolunteersYes
Study Sites224

Inclusion Criteria: * Signed and dated written informed consent form and any required privacy authorization prior to the initiation of any trial procedure, after the nature of the trial has been explained according to local regulatory requirements; * Females, ≥ 40 up to ≤ 65 years of age at randomi...

Countries:United StatesArgentinaBrazilCanadaCzechiaHungaryItalyLithuaniaPolandRomaniaRussiaSlovakiaSpainUnited Kingdom
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