Finerenone benefits in heart failure consistent regardless of diabetes status
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Key takeaways:
- Finerenone improved outcomes in certain patients with heart failure regardless of whether they had diabetes.
- Finerenone was linked with reduced risk for new-onset diabetes in patients without diabetes.
In patients with heart failure and mildly reduced or preserved ejection fraction, finerenone improved outcomes compared with placebo regardless of baseline diabetes status, according to new data from the FINEARTS-HF trial.
In addition, in patients without diabetes at baseline, those assigned finerenone (Kerendia, Bayer) were less likely to develop diabetes during the study, John J.V. McMurray, MD, professor of cardiology at the Institute of Cardiovascular and Medical Sciences at University of Glasgow in Scotland, said during a presentation at the European Association for the Study of Diabetes annual meeting.
As Healio previously reported, in the main results of FINEARTS-HF, patients with heart failure and mildly reduced or preserved ejection fraction (mean age, 72 years; 45% women) assigned finerenone, a nonsteroidal mineralocorticoid receptor antagonist, had reduced risk for the primary outcome of cardiovascular death or total worsening heart failure events over a median follow-up of 32 months compared with those assigned placebo.
For the present prespecified subanalysis, McMurray and colleagues examined whether there were any differences in the primary outcome according to baseline type 2 diabetes status, and whether finerenone impacted the development of new-onset diabetes in patients without diabetes at baseline.
“Finerenone ... has been shown to be a benefit in patients with type 2 diabetes and chronic kidney disease, so we examined whether or not finerenone would be beneficial in patients with heart failure and mildly reduced or preserved ejection fraction ... with and without type 2 diabetes,” McMurray said during a presentation. “This is the first large-scale experience using finerenone in any group of patients without type 2 diabetes.”
Diabetes vs. no diabetes
Compared with patients without diabetes, patients with diabetes were younger, had higher BMI, had worse kidney function, were less likely to be women and were more likely to have a history of hospitalization for heart failure or myocardial infarction, McMurray said during the presentation. In addition, he said those with diabetes were more likely to be on an SGLT2 inhibitor at baseline.
The treatment effect of finerenone for the primary outcome was almost identical in patients with diabetes (HR = 0.83; 95% CI, 0.69-1) and in patients without diabetes (HR = 0.84; 95% CI, 0.7-1; P for interaction = .91), McMurray said, noting that the treatment effect of finerenone for total worsening heart failure events, CV death and all-cause death was also similar in those with and without diabetes.
When HbA1c was used as a continuous variable, there remained no difference in treatment effect (P for interaction = .19), he said.
“The findings were consistent in those individuals with and without type 2 diabetes at baseline,” McMurray said during the presentation.
Impact on new-onset diabetes
Among those without diabetes at baseline, characteristics were balanced between those assigned finerenone and those assigned placebo, and slightly more than 60% had prediabetes, McMurray said during the presentation.
The finerenone group had reduced risk for development of new-onset diabetes compared with the placebo group regardless of whether initiation of SGLT2 inhibitors during the study period was excluded from the definition of new-onset diabetes (subdistribution HR = 0.75; 95% CI, 0.59-0.96) or was included (subdistribution HR = 0.73; 95% CI, 0.58-0.93), he said.
The new-onset diabetes results did not vary by prespecified subgroups, including according to BMI, waist circumference or glycemic status, he said.
“The most interesting finding here is that finerenone reduced the incidence of new diabetes by about a quarter in these patients with heart failure and mildly reduced or preserved ejection fraction,” McMurray said during the presentation.
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McMurray JJV, et al. LBA04. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 9-13, 2024; Madrid, Spain.
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