finerenone (Kerendia)
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Indications
- diabetic nephropathy*
- reduces adverse events related to heart failure, HFrEF or HFpEF, & reduces cardiovascular mortality[6][7][9]
- finerenone reduces worsening heart failure despite frailty status[11]
- FDA-approved for use in patients with heart failure LVEF >= 40%
* improves urine albumin/creatinine
- initial therapy with finerenone + empagliflozin reduces urinary albuminuria > either treatment alone[10]
Contraindications
- not for use in patients without diabetes mellitus[12]
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: 10 mg, 20 mg
Monitor
Adverse effects
- hyperkalemia (18%)[5]
- hypotension (5%)
- hyponatremia (1%)
* causes less hyperkalemia than spironolactone or eplerenone
* does not cause gynecomastia
- drug adverse effects of renin-angiotensin-aldosterone system inhibitors (RAAS inhibitors)
- drug adverse effects of antihypertensive agents
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]
More general terms
- heterocyclic compound, 2 rings
- amide
- amine
- ether
- nitrile
- renin-angiotensin-aldosterone system inhibitor (RAAS inhibitor)
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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/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://pubmed.ncbi.nlm.nih.gov/38048573 https://www.acpjournals.org/doi/10.7326/M23-1023
- ↑ 6.0 6.1 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: https://pubmed.ncbi.nlm.nih.gov/39225278 https://www.nejm.org/doi/10.1056/NEJMoa2407107
- ↑ 7.0 7.1 Yang M, Henderson AD, Talebi A Effect of Finerenone on the KCCQ in Patients With HFmrEF/HFpEF: A Prespecified Analysis of FINEARTS-HF. PMID: https://pubmed.ncbi.nlm.nih.gov/39520455 Free article. https://www.sciencedirect.com/science/article/pii/S0735109724085322
- ↑ Butt JH, Henderson AD, Jhund PS et al Finerenone, Obesity, and Heart Failure With Mildly Reduced/Preserved Ejection Fraction: Prespecified Analysis of FINEARTS-HF. J Am Coll Cardiol. 2024 Dec 4:S0735-1097(24)10423-8. PMID: https://pubmed.ncbi.nlm.nih.gov/39665701 Free article.
- ↑ 9.0 9.1 DuBosar R Finerenone is effective for heart failure with mildly reduced or preserved ejection fraction. ACP Hospitalist. March 12, 2025 https://acphospitalist.acponline.org/archives/2025/03/12/finerenone-is-effective-for-heart-failure-with-mildly-reduced-or-preserved-ejection-fraction.htm
McDowell K, Docherty KF, Campbell RT et al Finerenone for Heart Failure and Risk Estimated by the PREDICT-HFpEF Model: A Secondary Analysis of FINEARTS-HF. JAMA Cardiol. 2025 Mar 5:e250025. PMID: https://pubmed.ncbi.nlm.nih.gov/40042880 PMCID: PMC11883611 (available on 2026-03-05) - ↑ 10.0 10.1 Agarwal R, et al. Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes. N Engl J Med. 2025. June 5. PMID: https://pubmed.ncbi.nlm.nih.gov/40470996 https://www.nejm.org/doi/full/10.1056/NEJMoa2410659
- ↑ 11.0 11.1 finerenone reduces worsening heart failure despite frailty status I.M. Matters Weekly. June 24, 2025 https://immattersacp.org/weekly/archives/2025/06/24/
- ↑ 12.0 12.1 Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
- ↑ Cox CE FDA Approves Finerenone for HF Patients With Mildly Reduced or Preserved EF. tcdMD. July 14, 2025 https://www.tctmd.com/news/fda-approves-finerenone-hf-patients-mildly-reduced-or-preserved-ef
- ↑ Medscape: finerenone (Rx) https://reference.medscape.com/drug/kerendia-finerenone-4000168