From the Guidelines
Finerenone is indicated for the treatment of patients with type 2 diabetes and chronic kidney disease to reduce the risk of kidney function decline, kidney failure, cardiovascular death, non-fatal heart attacks, and hospitalization for heart failure, but it is not currently FDA-approved for heart failure treatment. The medication works by blocking mineralocorticoid receptors, reducing inflammation and fibrosis in both kidney and cardiac tissue, which explains its cardiovascular benefits in diabetic kidney disease patients 1. According to the most recent study, finerenone reduced the primary outcome of death from cardiovascular causes, nonfatal MI, nonfatal stroke, or hospitalization for heart failure (HR 0.87 [95% CI 0.76–0.98]; P = 0.03) in people with type 2 diabetes and CKD 1. Some key points to consider when prescribing finerenone include:
- The primary composite outcome was cardiovascular death, myocardial infarction, stroke, and hospitalization for heart failure, which was reduced by 13% in the finerenone group compared with the placebo group 1.
- The benefit was primarily driven by a reduction in heart failure hospitalizations: 3.2% vs. 4.4% in the placebo group (HR 0.71 [95% CI 0.56–0.90]) 1.
- There was a higher incidence of hyperkalemia in the finerenone group, 10.8% vs. 5.3%, although only 1.2% of the 3,686 individuals on finerenone stopped the study due to hyperkalemia 1. Clinical trials investigating finerenone specifically for heart failure are ongoing, but until these studies are completed and regulatory approval is granted, it should not be prescribed primarily for heart failure management 1. Patients with heart failure should instead be treated with guideline-directed medical therapy including ACE inhibitors/ARBs, beta-blockers, and approved mineralocorticoid receptor antagonists like spironolactone or eplerenone when indicated.
From the Research
Indication for Heart Failure
- Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, has been shown to have favorable effects on cardiorenal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes 2, 3, 4, 5, 6.
- The use of finerenone in patients with CKD and type 2 diabetes has been associated with a reduced risk of hospitalization for heart failure, as well as a lower incidence of cardiovascular events 2, 4.
- Recent studies have also demonstrated the potential benefits of finerenone in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) 3, 5.
- The FINEARTS-HF trial showed a significant reduction in the risk of worsening heart failure events and death from cardiovascular causes with finerenone versus placebo in patients with HFmrEF/HFpEF 5.
Mechanism of Action
- Finerenone works by selectively blocking the mineralocorticoid receptor, which is involved in the regulation of blood pressure and fluid balance in the body 3, 5.
- This mechanism of action is thought to contribute to the drug's ability to reduce the risk of heart failure and other cardiovascular events 2, 4.
Clinical Evidence
- The FIGARO-DKD trial demonstrated that finerenone reduces the risk of new-onset heart failure and improves other heart failure outcomes in patients with CKD and type 2 diabetes 4.
- The FIDELIO-DKD and FIGARO-DKD trials also showed that finerenone improves cardiovascular outcomes in patients with albuminuric CKD and type 2 diabetes 2, 4.
- Ongoing studies, such as REDEFINE-HF, CONFIRMATION-HF, and FINALITY-HF, will further examine the potential role of finerenone in heart failure across a broad spectrum of ejection fractions and different clinical settings 5.