From the Guidelines
Finerenone should be initiated at a dose of 10 mg once daily for patients with an estimated glomerular filtration rate (eGFR) of 25-60 mL/min/1.73 m², and at 20 mg once daily for those with an eGFR >60 mL/min/1.73 m², with the option to increase the dose to 20 mg once daily after 1 month if serum potassium remains ≤4.8 mmol/L and renal function is stable 1. The dosing of finerenone is based on the patient's eGFR, with a starting dose of 10 mg once daily for those with an eGFR between 25 and 60 mL/min/1.73 m², and 20 mg once daily for those with an eGFR >60 mL/min/1.73 m².
- Key considerations for dosing finerenone include:
- Initial dose: 10 mg once daily for eGFR 25-60 mL/min/1.73 m², and 20 mg once daily for eGFR >60 mL/min/1.73 m²
- Dose increase: can be increased to 20 mg once daily after 1 month if serum potassium remains ≤4.8 mmol/L and renal function is stable
- Monitoring: regular monitoring of serum potassium levels is essential, particularly during the first 4 weeks of treatment and after any dose adjustments
- Hyperkalemia management: if hyperkalemia develops (potassium >5.5 mmol/L), the medication should be temporarily withheld until potassium normalizes Finerenone has been shown to reduce cardiovascular events and slow kidney disease progression in patients with type 2 diabetes and chronic kidney disease, making it a valuable treatment option for these patients 1.
From the Research
Dosing of Finerenone
- The dosing of finerenone is typically 10 or 20 mg once daily, as seen in the FIDELIO-DKD phase III trial 2.
- The exposure-response relationship of finerenone was characterized by a maximum effect model, estimating a low half-maximal effect concentration at 0.166 µg/L and a maximal hazard decrease at 36.1% 2.
- Finerenone effects on kidney outcomes approached saturation towards 20 mg once daily, and sodium-glucose transport protein 2 inhibitor use provided additive benefits 2.
- The FIDELIO-DKD trial used titrated finerenone doses of 10 or 20 mg once daily, with a median follow-up of 2.6 years 2.
- There is no mention of a specific dosing regimen for finerenone in the other studies, but the FIDELIO-DKD trial provides the most detailed information on dosing 3, 4, 5, 6.
Key Findings
- Finerenone has been shown to reduce the risk of new-onset heart failure and improve other heart failure outcomes in patients with chronic kidney disease and type 2 diabetes 5.
- Finerenone also reduces the risk of hospitalization from heart failure and the composite kidney outcome 6.
- The efficacy and safety of finerenone on cardiovascular, kidney, and mortality outcomes have been demonstrated in several clinical trials 3, 4, 5, 2, 6.
Study Results
- The FIDELIO-DKD trial demonstrated that finerenone delayed chronic kidney disease progression and reduced cardiovascular events in patients with chronic kidney disease and type 2 diabetes 2.
- The FIGARO-DKD trial showed that finerenone reduced new-onset heart failure and improved other heart failure outcomes in patients with chronic kidney disease and type 2 diabetes 5.
- The FINE-HEART pooled analysis demonstrated that finerenone reduced the risks for deaths of any cause, cardiovascular events, and kidney outcomes 6.