Finerenone: A New Era for Mineralocorticoid Receptor Antagonism and Cardiorenal Protection

Parfianowicz, Dominic; Shah, Swara; Nguyen, Catherine; Maitz, Theresa N.; Hajra, Adrija; Goel, Akshay; Sreenivasan, Jayakumar; Aronow, Wilbert S.; Vyas, Apurva; Gupta, Rahul

doi:10.1016/j.cpcardiol.2022.101386

Cited by 8 publications

(5 citation statements)

References 55 publications

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“…Studies have found finerenone not only inhibits MR and its cofactor involvement, but also inhibits expression of MR target genes such as serum- and glucocorticoid-inducible kinase 1, which has been found to associated with the development of hypertension, fibrosis, hypertension, and metabolic syndrome. 5 Finerenone is able to diminish the nuclear accumulation of MRs more efficiently, as well as further recruitments of additional MRs than its steroidal counterparts like spironolactone 2 (Fig. 2).…”

Section: Finerenone: a Nonsteroidal Mramentioning

confidence: 99%

“…2 Finerenone is a full antagonist in different MR mutant cell types that are responsible for early onset hypertension and gestational hypertension. 5 The unique binding to the MR by finerenone plays a direct role in inhibiting the MR signaling cascade as well as preventing cofactor recruitments. Through this process, it prevents transcription of downstream hypertrophic pro-inflammatory effects which has not been reported from older generation MRAs.…”

Section: Mechanism Of Actionmentioning

confidence: 99%

“…Episodes of hyponatremia and hypotension have also been described (Tables 1 and 2). 2,5,15 The recommended starting dosage of finerenone is 10 mg once daily if the eGFR is 25-60 mL/min/1.73 m 2 , and 20 mg if the eGFR is ≥60 mL/min/1.73 m 2 . After 4 weeks, the lower dose can be increased to 20 mg. Serum potassium levels should be measured before and 4 weeks after starting the drug.…”

Section: Clinical Use Of Finerenonementioning

confidence: 99%

“…2 Finerenone is a full antagonist in different MR mutant cell types that are responsible for early onset hypertension and gestational hypertension. 5…”

Section: Finerenone: a Nonsteroidal Mramentioning

confidence: 99%

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Finerenone: Efficacy of a New Nonsteroidal Mineralocorticoid Receptor Antagonist in Treatment of Patients With Chronic Kidney Disease and Type 2 Diabetes

Dey

Garg

Wang

et al. 2023

Cardiology in Review

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Mineralocorticoid receptor stimulation by aldosterone can cause various cardiovascular and renal disease complications. Finerenone is a new oral nonsteroidal mineralocorticoid receptor antagonist that has been approved for clinical use by the Federal Drug Aministration, and has been shown in clinical trials to reduce the risk of sustained estimated glomerular filtration rate decline, end-stage renal disease, nonfatal myocardial infarction, hospitalization for heart failure and cardiovascular death in adult patients with chronic kidney disease associated with type 2 diabetes. The drug has also been shown to have fewer side effects than the steroidal mineralocorticoid receptor antagonists like spironolactone and eplerenone. In this review article, the authors will discuss the clinical pharmacology of finerenone, its clinical application and the additional studies that are now underway to further assess the efficacy of the drug in diabetic patients having cardiac and renal disease.

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Section: Finerenone: a Nonsteroidal Mramentioning

confidence: 99%

Section: Mechanism Of Actionmentioning

confidence: 99%

Section: Clinical Use Of Finerenonementioning

confidence: 99%

“…2 Finerenone is a full antagonist in different MR mutant cell types that are responsible for early onset hypertension and gestational hypertension. 5…”

Section: Finerenone: a Nonsteroidal Mramentioning

confidence: 99%

See 2 more Smart Citations

Finerenone: Efficacy of a New Nonsteroidal Mineralocorticoid Receptor Antagonist in Treatment of Patients With Chronic Kidney Disease and Type 2 Diabetes

Dey

Garg

Wang

et al. 2023

Cardiology in Review

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show abstract

“…Due to their steroid-based nature, they bear a structural resemblance to aldosterone and cortisol. Consequently, a multitude of side effects associated with steroidal MRAs emerge, posing limitations or reduced desirability for their use [5]. The MRs exhibit widespread distribution across various tissues and organs, including the heart, kidney, brain, lung, colon, skin, liver, skeletal muscle, saliva, sweat glands, and adipose tissue [6].…”

Section: Mechanism Of Action and Pharmacodynamics Of Nonsteroidal Min...mentioning

confidence: 99%

Nonsteroidal Mineralocorticoid Receptor Antagonist (Finerenone) in Cardiorenal Disease

Shah,

Awad,

Abdel-Rahman

2023

JCM

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Nonsteroidal mineralocorticoid receptor antagonists (MRAs) present a promising therapeutic option in cardiorenal diseases, mitigating the limitations of steroidal MRAs. Finerenone, a third-generation nonsteroidal MRA, has demonstrated beneficial effects in heart failure (HF) and chronic kidney disease (CKD). Clinical trials, including FIDELIO-DKD and FIGARO-DKD, revealed finerenone’s efficacy in improving kidney and cardiovascular (CV) outcomes. Patients with CKD and type 2 diabetes (T2DM) on finerenone experienced reduced rates of cardiovascular events, including hospitalization for HF. However, these trials excluded symptomatic HF patients, focusing on asymptomatic or early-stage HF. The ongoing FINEARTS-HF trial evaluates finerenone in HF with preserved ejection fraction (HFpEF). Additionally, studies exploring finerenone and sodium-glucose cotransporter 2 (SGLT2) inhibitors’ (Empagliflozin) combination effects in CKD and T2DM (CONFIDENCE) and the selective MR modulator AZD9977 with another SGLT2 inhibitor (dapagliflozin) in HF and CKD (MIRACLE) aim to expand treatment options. While SGLT-2 inhibitors were shown to reduce hyperkalemia risk in FIDELIO-DKD and potentially lower new-onset HF incidence in FIGARO-DKD, further research is essential. So far, the evidence for the beneficial effect of finerenone in the spectrum of cardiorenal diseases is based only on the results of studies conducted in patients with T2DM, and clinical trials of finerenone in patients with nondiabetic kidney disease are ongoing. Nonsteroidal MRAs hold significant potential as pivotal treatment targets across the cardiorenal disease spectrum. This review will focus on the effects of finerenone on cardiorenal disease.

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The role of a novel mineralocorticoid receptor antagonist, finerenone, in chronic kidney disease: mechanisms and clinical advances

Chen,

Li,

Zhang

et al. 2023

Clin Exp Nephrol

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Finerenone: A New Era for Mineralocorticoid Receptor Antagonism and Cardiorenal Protection

Cited by 8 publications

References 55 publications

Finerenone: Efficacy of a New Nonsteroidal Mineralocorticoid Receptor Antagonist in Treatment of Patients With Chronic Kidney Disease and Type 2 Diabetes

Finerenone: Efficacy of a New Nonsteroidal Mineralocorticoid Receptor Antagonist in Treatment of Patients With Chronic Kidney Disease and Type 2 Diabetes

Nonsteroidal Mineralocorticoid Receptor Antagonist (Finerenone) in Cardiorenal Disease

The role of a novel mineralocorticoid receptor antagonist, finerenone, in chronic kidney disease: mechanisms and clinical advances

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