From the Research
Finerenone is recommended for patients with chronic heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) who remain symptomatic despite optimal treatment with other heart failure medications, as it reduces the risk of outpatient worsening heart failure events and improves cardiorenal outcomes, as shown in the FINEARTS-HF trial 1. The typical starting dose is 10 mg once daily, which may be increased to 20 mg once daily after 4 weeks if tolerated. Key considerations for initiating finerenone include:
- Checking potassium levels, which should be ≤5.0 mEq/L
- Ensuring an estimated glomerular filtration rate (eGFR) ≥25 mL/min/1.73m² Regular monitoring of potassium levels and kidney function is essential, particularly within the first 4 weeks of treatment and after dose increases. Finerenone works as a non-steroidal, selective mineralocorticoid receptor antagonist that reduces inflammation and fibrosis in both the heart and kidneys, offering benefits beyond traditional MRAs like spironolactone and eplerenone with potentially fewer side effects such as gynecomastia. The benefits of finerenone are consistent across different patient subgroups, including those with chronic obstructive pulmonary disease (COPD) 2, and those with chronic kidney disease and type 2 diabetes 3. Some key points to consider when prescribing finerenone include:
- Its effectiveness in reducing the risk of new-onset heart failure in patients with chronic kidney disease and type 2 diabetes 3
- Its ability to improve multiple pathophysiological parameters of heart failure with preserved ejection fraction (HFpEF) in preclinical models 4
- The importance of regular monitoring to minimize the risk of adverse events, such as hyperkalemia and kidney dysfunction.