Summary

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• Finerenone (Kerendia) is indicated to reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure in adult patients with chronic kidney disease associated with type 2 diabetes.
• Eighteen studies were reviewed to gather information about this drug's efficacy and safety profile.
• Compared to GLP1-RA and SGLT-2 inhibitors used for similar indications, finerenone shows comparable efficacy in reducing major adverse cardiovascular events (MACE) and slowing the progression of kidney disease. It also offers significant protection against hospitalization due to heart failure, which is not observed with GLP1-RAs.
• In terms of renal protection compared to placebo or other mineralocorticoid receptor antagonists like spironolactone or eplerenone, finerenone has been found superior in delaying the deterioration of kidney function. This includes a reduction in the urine albumin creatinine ratio (UACR) as well as prevention of a decline in estimated glomerular filtration rate (eGFR).
• The safety profile indicates an increased risk of hyperkalemia during therapy compared to both placebo and other therapeutic agents, but the overall side effect profile remains comparable. Compared specifically with MRAs, it might offer better safety outcomes, including lesser incidents related to hyperkalemia than spironolactone, along with improvements on the renal front without sexual side effects.
• For patients with established atherosclerotic cardiovascular diseases, consistent effectiveness was noted by studies regarding the reduction of risks related to MACE while using finerenone.
• In populations suffering from Type 2 Diabetes Mellitus alongside Chronic Kidney Disease, benefits are particularly notable, showcasing a dual cardiorenal protective effect offered by this drug.
• Finerenone presents itself as a promising option when comparing within its class and beyond, offering unique benefits, especially concerning hospitalizations due to heart failure and progression of kidney disease. Its efficacy in reducing MACE is on par with other leading therapies such as GLP1-RA and SGLT-2 inhibitors while offering a differentiated benefit in heart failure hospitalization prevention. Despite the challenge posed by hyperkalemia requiring monitoring, it does not detract significantly from its overall favorable benefit-risk profile.