Finerenone: features of action, current evidence base and examples of clinical application

The article is devoted to the pharmacological and impairment features of finerenone, a new non-steroidal antagonist of mineralocorticoid receptors (AMR), like other drugs, suppresses the activity of the renin-angiotensin-aldosterone system (RAAS), which plays a key role in the pathogenesis of cardiovascular diseases (CVD). Compared to other AMRs, finerenone more selectively and more tightly binds to mineralocorticoid receptors, which causes its pronounced anti-inflammatory, antifibrotic, antioxidant and other effects not only in the kidneys, but also in the heart and blood vessels. In several randomized trials — FIDELIO-DKD, FIGARO-DKD — in patients with type 2 diabetes mellitus (DM2) and chronic kidney disease (CKD) with albuinuria (AU), finerenone demonstrated a significant reduction of renal dysfunction progression, and in the treatment of FINEARTS-HF in patients with heart failure (HF) with a left ventricular ejection fraction ≥40%, finerenone was associated with a relatively low incidence of worsening HF and cardiovascular mortality compared with placebo. Pooled data from these three studies show a reduction of all-cause mortality, worsening HF, and renal adverse outcomes with finerenone.

In current guidelines, the finerenone is recommended for patients with DM2 and CKD with AU during cardiovascular events and renal failure. The article describe three clinical cases in which patients were prescribed finerenone as part of the preparation of the evidence base for this. One of these examples shows an improvement in renal function after the addition of finerenone alone.

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