Mithra receives guidance from the FDA for the DONESTA® NDA marketing authorization filing in the United States

  • DONESTA® for the treatment of vasomotor symptoms of menopause, is expected to target the entire accessible US market of nearly 63 million women between the ages of 45 and 65, pending FDA approval
  • Following FDA advice, preparation of filing is proceeding with a filing date now planned in Q4 2024
  • FDA marketing authorization, contingent upon successful completion of the approval process, now expected in Q4 2025
  • Agreement for US commercialization partner for DONESTA® now expected during 2024
  • Mithra to seek DONESTA® approval in US and Europe concurrently for the treatment of vasomotor symptoms of menopause; target submission date for EMA filing also expected in Q4 2024
  • Patent coverage in the US for DONESTA® as a treatment for vasomotor symptoms associated with menopause is expected until 2039


Liege, Belgium, 30 November 2023 – 7:00 CET – Mithra (Euronext Brussels: MITRA), a company dedicated to Women’s Health, today announces that the US Food and Drug Administration (FDA) has provided feedback regarding its new drug application (NDA) marketing authorization filing in the United States. This follows an agreement in principle with the FDA for Mithra to conduct additional endometrial data analyses. As a result, the formal NDA submission is now planned for Q4 2024 to allow for the time required to perform these additional analyses pursuant to FDA guidance.

Pending regulatory approval, DONESTA® is expected to target a US market of nearly 63 million women between the ages of 45 and 65 years-old and experiencing vasomotor symptoms of menopause (VMS). Due to the variation observed by Mithra in the endometrial biopsy diagnoses — which could have resulted in a limited addressable market for DONESTA®— the company has decided to conduct additional endometrial data analyses from its phase 3 program for the DONESTA® menopause candidate-medication. The delay will enable complementary data to be submitted and evaluated for both FDA and the European Medicines Agency (EMA) submissions within the same time frame. Mithra is actively continuing the process of collecting and providing all required data to the FDA for submission.

Mithra continues to actively seek a commercialization partner for the US market and has already received positive interest from several potential candidates. Mithra will continue to progress discussions with potential partners in parallel to the NDA submission process. Mithra recently announced licensing agreements in other regions (e.g., Canada and Europe). Mithra aims to establish an agreement for DONESTA® US commercialization during 2024. Mithra has engaged with Stifel as its financial advisor to oversee the process of establishing a commercialization partner for DONESTA®.

We strongly believe that DONESTA® will be a game-changer for the treatment of the symptoms of menopause and Women’s Health in the United States, Europe and other parts of the world,” said David H. Solomon, CEO of Mithra. “As with any new medication, obtaining clearance requires the necessary diligence and learning, and we have actively requested additional data analyses to ensure we prioritize an accurate assessment of the DONESTA® benefit-to-risk profile. DONESTA® has the potential to offer differentiated efficacy, safety and convenience to millions of women who are underserved and often suffer in silence from the symptoms of menopause. DONESTA® clinical results to date suggest it may be one of the biggest advances in menopausal hormone therapy in the past decades. DONESTA® and the potential benefits it will offer to women in the US is demonstrated by our recent commercialization deals in other regions throughout the world. Furthermore, we are excited that the FDA will review the DONESTA® file for the total applicable population in the US. With patent protection expected until 2039 in the US, we are excited about the long exclusivity period for DONESTA® in the treatment of the symptoms of menopause. We believe it is in our shareholders’ interest to take additional time to sign a US deal under conditions where the full value of DONESTA® will be captured; the delay affords us additional time to run our process and find the best partner,” said Mr. Solomon. “For this reason, we have updated our guidance while we focus on re-starting the review of the data and ensure the integrity of the regulatory process.

Graham Dixon, Chief Scientific Officer of Mithra added, “The FDA’s feedback is very valuable to facilitate the regulatory review process. These additional data will be submitted to the EMA in the same timeframe. This will allow Mithra to request marketing approvals to both the FDA and the EMA, concurrently. Estetrol’s action on the uterine lining is well understood and expected. These additional data inform our research on other promising applications of E4 in women’s health. In fact, this effect can potentially be used as a treatment to enhance fertility for women who are undergoing IVF, for example. We have begun research to explore an estetrol-based solution for this market.

DONESTA® is Mithra’s next generation orally administrated estrogen; an estetrol-based hormone therapy product candidate offering a potential long-term solution for treating various symptoms of menopause. Estetrol (E4) is the first native estrogen, present in developing human fetuses and is manufactured from a plant-based source.

E4 acts differently from classical estrogens. Its selective activation of nuclear estrogen receptors and its unique metabolism result in a low impact on haemostasis and breast tissue with an expected improvement in the benefit-to-risk profile. In early 2022, Mithra announced positive top-line efficacy results of the DONESTA® phase 3 program, which demonstrated a meaningful reduction in VMS from baseline and compared to placebo with all co-primary efficacy endpoints statistically met. Data also showed improved quality of life and reduction of genito-urinary symptoms of menopause, as secondary efficacy endpoints.


Please read this carefully as it applies to all persons who visit this website. The following pages contain information relating to an offering and/or admission to trading on a regulated market in relation to securities of Mithra Pharmaceuticals SA ("Mithra Pharmaceuticals"). This information may not be accessed by residents of certain countries based on applicable securities law regulations. Accordingly, if you wish to access this part of the website you must first inform yourself about and then observe the statutory and regulatory requirements applicable to you and to your jurisdiction. In order to establish whether or not you may view the information and documents please read the disclaimer below in full.


This website and the information contained herein or to which it gives access are not intended for, and may not be accessed by, or distributed or disseminated to, persons resident or physically present in the United States of America (including its territories, the "United States"), Australia, Japan or South Africa, and do not constitute, or form part of, an offer or invitation to sell or issue, or a solicitation of an offer or invitation to purchase or subscribe for, nor shall there be any sale or purchase of, any securities of Mithra Pharmaceuticals in the United States, Australia, Japan or South Africa or in any other jurisdiction in which such offer, invitation, solicitation, sale, issue, purchase or subscription would be unlawful prior to registration, unless an exemption from registration or qualification under the securities laws of any such jurisdiction is applicable. The securities of Mithra Pharmaceuticals referred to on this website have not been and will not be registered under the U.S. Securities Act of 1933, as amended (the "U.S. Securities Act"), and may not be offered or sold in the United States absent registration with the United States Securities and Exchange Commission or an exemption from registration under the U.S. Securities Act. There will be no public offering of Mithra Pharmaceuticals' securities in the United States.

All persons residing outside of the United States, Australia, Canada, Japan and South Africa who wish to access the documents contained on this website should first ensure that they are not subject to local laws or regulations that prohibit or restrict their right to access this website, or require registration or approval for any acquisition of securities by them. Mithra Pharmaceuticals assumes no responsibility if there is a violation of applicable law and regulations by any person.

No action has been taken by Mithra Pharmaceuticals that would permit an offer of Mithra's securities or the possession or distribution of the materials to which this website gives access or any other offering or publicity material relating to Mithra's securities in any jurisdiction where action for that purpose is required.

Mithra Pharmaceuticals has not authorised any public offering in any Member State of the European Economic Area. With respect to any Member State of the European Economic Area that has implemented Regulation 2017/1129 of the European Parliament and of the Council of 14 June 2017 on the prospectus to be published when securities are offered to the public or admitted to trading on a regulated market, and repealing Directive 2003/71/EC, as amended from time to time (together with any applicable implementing measures in such Member State, the "Prospectus Regulation"), this website and the information contained herein, or to which it gives access, is only addressed to, and is only directed at, qualified investors in that Member State within the meaning of the Prospectus Regulation.

In addition, in the United Kingdom, this website and the information contained herein, or to which it gives access, is addressed to, and directed only at: (a) persons who have professional experience in matters relating to investments falling within article 19(5) of the Financial Services and Markets Act 2000 (Financial Promotion) Order 2005, as amended (the "Order"), and (b) high net worth entities, and other persons to whom they may otherwise lawfully be communicated, falling within article 49(2) of the Order (all such persons together being referred to as "Relevant Persons"). In the United Kingdom, any investment or investment activity to which this website and the information contained herein, or to which it gives access, relates, is available only to Relevant Persons and will be engaged in only with Relevant Persons. Any person in the United Kingdom who is not a Relevant Person should not act or rely on this website and the information contained herein, or to which it gives access.

If you are not permitted to view materials on this website or are in any doubt as to whether you are permitted to view these materials, please exit this webpage. Access to electronic versions of these materials is being made available on this webpage by Mithra Pharmaceuticals in good faith and for information purposes only.

By checking the acceptance box below, you confirm and certify that: You are not a resident of or physically present in the United States, Australia, Canada, Japan or South Africa or any other restricted jurisdiction, and that you are either: (a) a resident of, and domiciled in, a Member State of the European Economic Area and a qualified investor within the meaning of the Prospectus Regulation, (b) a resident of, and domiciled in, the United Kingdom, a qualified investor within the meaning of the Prospectus Regulation and a Relevant Person, or (c) otherwise authorised to access this information pursuant to applicable laws or regulations.