Finerenon – nowa klasa niesteroidowych antagonistów receptora dla mineralokortykoidów. Nowe możliwości, nowe wskazania Artykuł przeglądowy
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Opublikowane:
mar 31, 2024
Słowa kluczowe:
finerenon, przewlekła choroba nerek, PChN, cukrzyca, niewydolność serca
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Abstrakt
Finerenon to pierwszy niesteroidowy antagonista receptora dla mineralokortykoidów, który dzięki unikalnym właściwościom farmakologicznym charakteryzuje się potwierdzoną wynikami badań klinicznych wysoką efektywnością działania skojarzoną ze znikomą liczbą działań niepożądanych. W programie badań III fazy znajdowały się dwa kluczowe badania: FIDELIO-DKD (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease) i FIGARO-DKD (Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease). Uczestniczyło w nich łącznie 13 171 osób z cukrzycową przewlekłą chorobą nerek (PChN) o różnym stopniu nasilenia. Ze względu na bardzo wysoką efektywność finerenon powinien być wdrażany w terapii u pacjentów z cukrzycą i PChN. Celem zastosowanego leczenia, poprzez hamowanie procesu zapalnego, jest nie tylko spowolnienie progresji PChN, ale także istotna redukcja ryzyka incydentów sercowo-naczyniowych. Terapia taka powinna być obowiązkowo rozpatrywana u pacjentów z PChN w przebiegu cukrzycy.
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Jak cytować
Grześk, G. (2024). Finerenon – nowa klasa niesteroidowych antagonistów receptora dla mineralokortykoidów. Nowe możliwości, nowe wskazania . Medycyna Faktów , 17(1(62), 158-163. https://doi.org/10.24292/01.MF.0124.25
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Bibliografia
1. McDonagh TA, Metra M, Adamo M et al.; ESC Scientific Document Group. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023; 44(37): 3627-39. http://doi.org/10.1093/eurheartj/ehad195. Erratum in: Eur Heart J. 2024; 45(1):53.
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.
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.