From the Guidelines
Finerenone is likely to cause less gynaecomastia compared to eplerenone, given its higher selectivity for the mineralocorticoid receptor and non-steroidal structure, which results in minimal binding to androgen and progesterone receptors. This is based on the understanding that finerenone, as a newer agent, is designed to have a more targeted effect on the mineralocorticoid receptor with fewer side effects compared to older MRAs like spironolactone and eplerenone. The difference in gynaecomastia rates among MRAs is attributed to their varying degrees of selectivity for the mineralocorticoid receptor and their potential to interact with androgen and progesterone receptors.
Key points to consider:
- Spironolactone has the highest rate of gynaecomastia due to its significant anti-androgenic effects.
- Eplerenone shows reduced rates of gynaecomastia (around 1-2%) because of its improved selectivity compared to spironolactone.
- Finerenone, with its non-steroidal structure, is expected to have an even lower incidence of gynaecomastia, making it a preferable option for male patients concerned about this side effect, as noted in the context of managing primary aldosteronism and heart failure 1.
- The choice between finerenone and eplerenone should also consider factors such as cost, specific approved indications, and the individual patient's clinical profile.
In clinical practice, when prescribing MRAs, particularly for male patients concerned about gynaecomastia, finerenone would be the preferred option if available and appropriate for the clinical indication, followed by eplerenone, with spironolactone being the most likely to cause this side effect 1. It's essential to weigh the benefits of each MRA against their potential side effects and consider the patient's overall health status and preferences.
From the Research
Comparison of Finerenone and Eplerenone
- Finerenone is a novel non-steroidal mineralocorticoid receptor antagonist (MRA) that has been shown to have a better safety profile compared to eplerenone, another MRA 2, 3.
- Studies have demonstrated that finerenone has a lower risk of hyperkalemia and adverse effects on renal function compared to eplerenone 3, 4.
- In terms of gynaecomastia, a common side effect of MRAs, finerenone has been shown to have no effect on sexual side effects, including gynecomastia, whereas eplerenone has been associated with a higher risk of gynecomastia 3, 5.
- A randomized controlled study comparing finerenone and eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease found that finerenone was well tolerated and induced a 30% or greater decrease in NT-proBNP levels in a similar proportion of patients to eplerenone, with a lower risk of clinical events 4.
Efficacy and Safety of Finerenone
- Finerenone has been shown to be effective in reducing the progression of renal disease and cardiovascular outcomes in patients with chronic kidney disease and type 2 diabetes 3, 6.
- The safety profile of finerenone has been evaluated in several studies, and it has been found to be well tolerated with a lower risk of hyperkalemia and adverse effects on renal function compared to other MRAs 2, 3, 4.
- Ongoing studies are investigating the potential role of finerenone in the management of heart failure across a broad spectrum of ejection fractions and different clinical settings 6.