Finerenone – a new class of non-steroidal mineralocorticoid receptor antagonists. New possibilities, new indications Review article
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Published:
Mar 31, 2024
Keywords:
finerenone, chronic kidney disease, CKD, diabetes, heart failure
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Abstract
Finerenone is the first non-steroidal mineralocorticoid receptor antagonist. Thanks to its unique pharmacological properties, it is characterized by high effectiveness, as confirmed by clinical trial results, and a small number of side effects. The phase III research program included two key studies: FIDELIO-DKD (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease) and FIGARO-DKD (Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease). A total of 13,171 people with diabetic chronic kidney disease (CKD) of various degrees of severity participated. Due to its very high effectiveness, finerenone should be implemented in the therapy of patients with diabetes and CKD. The aim of the treatment is to inhibit the inflammatory process, not only to slow down the progression of CKD but also to significantly reduce the risk of cardiovascular events. Such therapy should be mandatory for patients with CKD due to diabetes.
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Grześk, G. (2024). Finerenone – a new class of non-steroidal mineralocorticoid receptor antagonists. New possibilities, new indications. Medycyna Faktow (J EBM), 17(1(62), 158-163. https://doi.org/10.24292/01.MF.0124.25
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References
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13. Rossing P, Anker SD, Filippatos G et al.; FIDELIO-DKD and FIGARO-DKD Investigators. Finerenone in Patients With Chronic Kidney Disease and Type 2 Diabetes by Sodium-Glucose Cotransporter 2 Inhibitor Treatment: The FIDELITY Analysis. Diabetes Care. 2022; 45(12): 2991-8. http://doi.org/10.2337/dc22-0294.
14. Mårup FH, Thomsen MB, Birn H. Additive effects of dapagliflozin and finerenone on albuminuria in non-diabetic CKD: an open-label randomized clinical trial. Clin Kidney J. 2023; 17(1): sfad249. http://doi.org/10.1093/ckj/sfad249.
15. Neuen BL, Heerspink HJL, Vart P et al. Estimated Lifetime Cardiovascular, Kidney, and Mortality Benefits of Combination Treatment With SGLT2 Inhibitors, GLP-1 Receptor Agonists, and Nonsteroidal MRA Compared With Conventional Care in Patients With Type 2 Diabetes and Albuminuria. Circulation. 2024; 149(6): 450-62. http://doi.org/10.1161/CIRCULATIONAHA.123.067584.
16. Marx N, Federici M, Schütt K et al.; ESC Scientific Document Group. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023; 44(39): 4043-140. http://doi.org/10.1093/eurheartj/ehad192. Erratum in: Eur Heart J. 2023; 44(48): 5060; Eur Heart J. 2024; 45(7): 518.
2. Williams B, Mancia G, Spiering W et al.; Authors/Task Force Members. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018; 36(10): 1953-2041. http://doi.org/10.1097/HJH.0000000000001940. Erratum in: J Hypertens. 2019; 37(1): 226.
3. Grześk G, Bogdan M, Kubica A et al. Zastosowanie antagonistów receptora dla aldosteronu w leczeniu niewydolności serca. Choroby Serca i Naczyń. 2005; 2(1): 29-32.
4. Pitt B, Kober L, Ponikowski P et al. Safety and tolerability of the novel non-steroidal mineralocorticoid receptor antagonist BAY 94-8862 in patients with chronic heart failure and mild or moderate chronic kidney disease: a randomized, double-blind trial. Eur Heart J. 2013; 34(31): 2453-63. http://doi.org/10.1093/eurheartj/eht187.
5. Filippatos G, Anker SD, Böhm M et al. A randomized controlled study of finerenone vs. eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease. Eur Heart J. 2016; 37(27): 2105-14. http://doi.org/10.1093/eurheartj/ehw132.
6. Pitt B, Anker SD, Böhm M, Gheorghiade M et al. Rationale and design of MinerAlocorticoid Receptor antagonist Tolerability Study-Heart Failure (ARTS-HF): a randomized study of finerenone vs. eplerenone in patients who have worsening chronic heart failure with diabetes and/or chronic kidney disease. Eur J Heart Fail. 2015; 17(2): 224-32. http://doi.org/10.1002/ejhf.218.
7. Bakris GL, Agarwal R, Anker SD et al.; FIDELIO-DKD Investigators. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med. 2020; 383(23): 2219-29. http://doi.org/10.1056/NEJMoa2025845.
8. Filippatos G, Anker SD, August P et al. Finerenone and effects on mortality in chronic kidney disease and type 2 diabetes: a FIDELITY analysis. Eur Heart J Cardiovasc Pharmacother. 2023; 9(2): 183-91. http://doi.org/10.1093/ehjcvp/pvad001.
9. Filippatos G, Pitt B, Agarwal R et al.; FIDELIO-DKD Investigators. Finerenone in patients with chronic kidney disease and type 2 diabetes with and without heart failure: a prespecified subgroup analysis of the FIDELIO-DKD trial. Eur J Heart Fail. 2022; 24(6): 996-1005. http://doi.org/10.1002/ejhf.2469.
10. Yang S, Shen W, Zhang HZ et al. Efficacy and Safety of Finerenone for Prevention of Cardiovascular Events in Type 2 Diabetes Mellitus With Chronic Kidney Disease: A Meta-analysis of Randomized Controlled Trials. J Cardiovasc Pharmacol. 2023; 81(1): 55-62. http://doi.org/10.1097/FJC.0000000000001364.
11. Filippatos G, Bakris GL, Pitt B et al.; FIDELIO-DKD Investigators. Finerenone Reduces New-Onset Atrial Fibrillation in Patients With Chronic Kidney Disease and Type 2 Diabetes. J Am Coll Cardiol. 2021; 78(2): 142-52. http://doi.org/10.1016/j.jacc.2021.04.079.
12. Zhang Y, Wang J, Jiang L et al. Network meta-analysis on the efficacy and safety of finerenone versus SGLT2 inhibitors on reducing new-onset of atrial fibrillation in patients with type 2 diabetes mellitus and chronic kidney disease. Diabetol Metab Syndr. 2022; 14(1): 156. http://doi.org/10.1186/s13098-022-00929-3.
13. Rossing P, Anker SD, Filippatos G et al.; FIDELIO-DKD and FIGARO-DKD Investigators. Finerenone in Patients With Chronic Kidney Disease and Type 2 Diabetes by Sodium-Glucose Cotransporter 2 Inhibitor Treatment: The FIDELITY Analysis. Diabetes Care. 2022; 45(12): 2991-8. http://doi.org/10.2337/dc22-0294.
14. Mårup FH, Thomsen MB, Birn H. Additive effects of dapagliflozin and finerenone on albuminuria in non-diabetic CKD: an open-label randomized clinical trial. Clin Kidney J. 2023; 17(1): sfad249. http://doi.org/10.1093/ckj/sfad249.
15. Neuen BL, Heerspink HJL, Vart P et al. Estimated Lifetime Cardiovascular, Kidney, and Mortality Benefits of Combination Treatment With SGLT2 Inhibitors, GLP-1 Receptor Agonists, and Nonsteroidal MRA Compared With Conventional Care in Patients With Type 2 Diabetes and Albuminuria. Circulation. 2024; 149(6): 450-62. http://doi.org/10.1161/CIRCULATIONAHA.123.067584.
16. Marx N, Federici M, Schütt K et al.; ESC Scientific Document Group. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023; 44(39): 4043-140. http://doi.org/10.1093/eurheartj/ehad192. Erratum in: Eur Heart J. 2023; 44(48): 5060; Eur Heart J. 2024; 45(7): 518.