finerenone (Kerendia)
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Indications
* improves urine albumin/creatinine
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
Dosage
Tablets: 19 mg, 20 mg
Monitor
Adverse effects
- hyperkalemia (18%)[5]
- hypotension (5%)
- hyponatremia (1%)
* causes less hyperkalemia than spironolactone or eplerenone
* does not cause gynecomastia
Mechanism of action
- 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]
More general terms
References
- ↑ 1.0 1.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26325557 <Internet> http://jama.jamanetwork.com/article.aspx?articleID=2432163
- ↑ 2.0 2.1 2.2 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/33095527 https://www.nejm.org/doi/full/10.1056/NEJMe2031382 - ↑ 3.0 3.1 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: https://www.ncbi.nlm.nih.gov/pubmed/34449181 https://www.nejm.org/doi/10.1056/NEJMoa2110956
- ↑ 4.0 4.1 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: https://www.ncbi.nlm.nih.gov/pubmed/36287567 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797719
- ↑ 5.0 5.1 5.2 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: https://www.ncbi.nlm.nih.gov/pubmed/38048573 https://www.acpjournals.org/doi/10.7326/M23-1023
- ↑ Medscape: finerenone (Rx) https://reference.medscape.com/drug/kerendia-finerenone-4000168