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finerenone (Kerendia)

Indications: - diabetic nephropathy* - reduces adverse events related to heart failure, HFrEF or HFpEF, & reduces cardiovascular mortality [6] * improves urine albumin/creatinine * no effect on GFR [1] Dosage: - 7.5-20 mg PO QD Tablets: 10 mg, 20 mg Benefit/risk: - prevention of CKD progression* or renal death (within median of 2.6 years) - 18% vs 21% for placebo - number needed to treat to prevent one case is 29 [2] - finerenone may be associated with protection from pneumonia in patients with diabetic nephropathy [4] * CKD progression: >40% decrease in eGFR relative to baseline for >4 weeks Monitor: - serum potassium Adverse effects: - hyperkalemia (18%) [5] - hypotension (5%) - hyponatremia (1%) * causes less hyperkalemia than spironolactone or eplerenone * does not cause gynecomastia Mechanism of action: - non-steroidal mineralocorticoid receptor antagonist - anti-inflammatory & anti-fibrotic agent [2] - reduction in microalbuminuria by finerenone attenuates progression of diabetic nephropathy & reduces risk of cardiovascular events [5] Clinical trials: - lowers risk for progression of diabetic nephropathy - improves cardiovascular outcomes in patients with CKD2 to CKD4 & albuminuria [3]

Interactions

drug adverse effects of renin-angiotensin-aldosterone system inhibitors (RAAS inhibitors)

General

heterocyclic compound, 2 rings amide amine ether nitrile renin-angiotensin-aldosterone system inhibitor (RAAS inhibitor)

Database Correlations

PUBCHEM cid=60150535

References

  1. Bakris GL, Agarwal R, Chan JC et al Effect of Finerenone on Albuminuria in Patients With Diabetic Nephropathy. A Randomized Clinical Trial JAMA. 2015;314(9):884-894 PMID: 26325557 http://jama.jamanetwork.com/article.aspx?articleID=2432163
  2. Bakris GL, Agarwal B, Anker SD et al Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med. 2020. Oct 3. PMID: 33264825 https://www.nejm.org/doi/full/10.1056/NEJMoa2025845 - Ingelfinger JR, Rosen CJ Finerenone - Halting Relative Hyperaldosteronism in Chronic Kidney Disease. N Engl J Med. 2020. Oct 3. PMID: 33095527 https://www.nejm.org/doi/full/10.1056/NEJMe2031382
  3. Pitt B, Filippatos G, Agarwal R et al. Cardiovascular events with finerenone in kidney disease and type 2 diabetes. N Engl J Med 2021 Aug 28; PMID: 34449181 https://www.nejm.org/doi/10.1056/NEJMoa2110956
  4. Pitt B, Agarwal R, Anker SD et al Association of Finerenone Use With Reduction in Treatment-Emergent Pneumonia and COVID-19 Adverse Events Among Patients With Type 2 Diabetes and Chronic Kidney Disease. A FIDELITY Pooled Secondary Analysis. JAMA Netw Open. 2022;5(10):e2236123 PMID: 36287567 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797719
  5. Agarwal R, Tu W, Farjat AE et al Impact of Finerenone-Induced Albuminuria Reduction on Chronic Kidney Disease Outcomes in Type 2 Diabetes. A Mediation Analysis. Ann Intern Med. 2023. Dec 5 PMID: 38048573 https://www.acpjournals.org/doi/10.7326/M23-1023
  6. Solomon SD et al. Finerenone in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med 2024 Sep 1; [e-pub]. PMID: 39225278 https://www.nejm.org/doi/10.1056/NEJMoa2407107
  7. Medscape: finerenone (Rx) https://reference.medscape.com/drug/kerendia-finerenone-4000168