Benefits of finerenone consistent in HF regardless if EF midrange or preserved
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Key takeaways:
- Finerenone improved outcomes in patients with heart failure along the entire ejection fraction spectrum above 40%.
- Finerenone may be recommended for treatment of patients with HF and midrange or preserved EF.
New data from the FINEARTS-HF trial show that finerenone improved outcomes in patients with HF compared with placebo across the entire midrange and preserved ejection fraction ranges.
As Healio previously reported, in the main results of FINEARTS-HF, the nonsteroidal mineralocorticoid receptor antagonist finerenone (Kerendia, Bayer) reduced risk for CV death and worsening HF by 16% compared with placebo at 32 months.
John J.V. McMurray, MD, professor of cardiology at the Institute of Cardiovascular and Medical Sciences at University of Glasgow in Scotland, presented a prespecified analysis of the results stratified by left ventricular EF range and using LVEF as a continuous variable during a virtual late-breaking clinical research session of the Heart Failure Society of America Annual Scientific Meeting. The in-person meeting was canceled due to Hurricane Helene.
“Prior analyses had suggested attenuation or loss of effect of some drugs (eg, sacubitril/valsartan (Entresto, Novartis) once the LVEF was above 55% to 60%, and as a result in many guidelines, neurohumoral therapies are only recommended in patients with [HF with midrange EF] and not [HF with preserved EF],” McMurray told Healio.
For the analysis, which was simultaneously published in Circulation, the researchers included 2,172 patients with LVEF 40% to 49% (mean age, 70 years; 31% women), 2,674 patients with LVEF 50% to 59% (mean age, 73 years; 51% women) and 1,147 patients with LVEF 60% or more (mean age, 74 years; 59% women).
The primary outcome of CV death and total HF events (hospitalizations or urgent visits) favored finerenone over placebo in patients with LVEF 40% to 49% (RR = 0.84; 95% CI, 0.68-1.03), in patients with LVEF 50% to 59% (RR = 0.8; 95% CI, 0.66-0.97) and in patients with LVEF 60% or more (RR = 0.94; 95% CI, 0.7-1.25; P for interaction = .7), McMurray said during the presentation, noting there was no significant interaction by LVEF for any secondary outcomes. The results did not change after adjustment for baseline characteristics.
When LVEF was analyzed as a continuous variable, there was no effect on the treatment effect of finerenone across the LVEF range (P for interaction for the primary outcome = .28; P for interaction for worsening HF events = .26), according to the researchers.
“We found no evidence that LVEF modified the effect of finerenone,” McMurray told Healio. “Finerenone will likely be recommended for treatment of both [HF with midrange EF] and HFpEF.”
Reference:
For more information:
John J.V. McMurray, MD, can be reached at @john.mcmurray@glasgow.ac.uk.
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McMurray JJV, et al. Late breaking clinical research session I. Presented at: The Heart Failure Society of America Annual Scientific Meeting; Sept. 27-30, 2024 (virtual meeting).
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