Finerenone associated with lower albuminuria risks for adults with heart failure
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Key takeaways:
- For adults with mild heart failure, finerenone was not associated with eGFR benefits compared with placebo.
- Finerenone was linked to reductions in albuminuria and risks for new-onset albuminuria.
SAN DIEGO — Compared with placebo, finerenone was associated with reductions in albuminuria and decreased risk of new-onset albuminuria among adults with heart failure, according to data from the FINEARTS-HF trial.
Finerenone use did not affect eGFR decline in the long term compared with placebo.
Data were presented at ASN Kidney Week and published simultaneously in the Journal of the American College of Cardiology.
“Overall, these data provide important information on expected changes in kidney biomarkers when prescribing finerenone for patients with [heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction] HFmrEF/HFpEF,” Finnian R. McCausland, MBBCh, MMSc, assistant professor of medicine at Harvard Medical School, said during a press briefing.
In FINEARTS-HF, researchers randomized 6,001 adults with symptomatic HFmrEF/HFpEF, 1:1, to finerenone or placebo. Mean eGFR was 62 mL/min/1.73 m2; 52% had an eGFR at least 60 mL/min/1.73 m2; 26% had an eGFR greater than 45 mL/min/1.73 m2 and less than 60 mL/min/1.73 m2; and 22% had an eGFR less than 45 mL/min/1.73 m2.
During 2.6 years of follow-up, the composite renal endpoint of long-term dialysis or transplant, sustained eGFR decline of at least 50% or sustained eGFR of less than 15 mL/min/1.73 m2 was reached by a similar percentage of participants in the finerenone (2.5%) and placebo (1.8%) groups. Results were similar when the rate of sustained eGFR decline was at least 57% — 1.4% of the finerenone group and 1% of the placebo group.
Urine albumin-to-creatinine ratio was 30% lower (95% CI, 25%-34%) for 6 months with finerenone vs. placebo. Risk of new-onset microalbuminuria was 24% lower for the finerenone group (HR = 0.76; 95% CI, 0.68-0.83), and new-onset macroalbuminuria risk was 38% lower (HR = 0.62; 95% CI, 0.53-0.73).
Finerenone is “clearly superior” for reducing kidney disease risks for adults with chronic kidney disease and type 2 diabetes, McCausland said.
“Heart failure has been a little bit more challenging in terms of looking at kidney composite outcomes, because the populations are quite different,” he said.
“Among patients with HFmrEF/HFpEF in FINEARTS-HF, who were at relatively low risk of adverse kidney events, finerenone did not alter the frequency of the prespecified kidney composite outcome. Finerenone caused an initial expected decline in eGFR, but did not alter longer-term eGFR trajectory, compared with placebo. [However,] finerenone caused an early and sustained lowering of albuminuria and lowered the risk of new-onset micro- and macroalbuminuria,” McCausland said.
Reference:
McCausland FR, et al. JACC. 2024;doi:10.1016/j.jacc.2024.10.091.
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McCausland FR, et al. FR-OR100. Presented at: ASN Kidney Week; Oct. 24-27, 2024; San Diego.
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