Finerenone: third-generation mineralocorticoid receptor antagonist for the treatment of heart failure and diabetic kidney disease

Licette C. Y. Liu, Elise Schutte, Ron T. Gansevoort, Peter van der Meer, Adriaan A. Voors*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

43 Citations (Scopus)

Abstract

Introduction: The mineralocorticoid receptor antagonists (MRAs) spironolactone and eplerenone reduce the risk of hospitalizations and mortality in patients with heart failure (HF) with reduced ejection fraction (HFrEF), and attenuate progression of diabetic kidney disease. However, their use is limited by the fear of inducing hyperkalennia, especially in patients with renal dysfunction. Finerenone is a novel nonsteroidal MRA, with higher selectivity toward the mineralocorticoid receptor (MR) compared to spironolactone and stronger MR-binding affinity than eplerenone.

Areas covered: This paper discusses the chemistry, pharmacokinetics, clinical efficacy and safety of finerenone.

Expert opinion: The selectivity and greater binding affinity of finerenone to the MR may reduce the risk of hyperkalemia and renal dysfunction and thereby overcome the reluctance to start and uptitrate MRAs in patients with HF and diabetic kidney disease. Studies conducted in patients with HFrEF and moderate chronic kidney disease and diabetic kidney disease, showed promising results. Phase Ill trials will have to show whether finerenone might become the third-generation MRA for the treatment of HF and diabetic kidney disease.

Original languageEnglish
Pages (from-to)1123-1135
Number of pages13
JournalExpert opinion on investigational drugs
Volume24
Issue number8
DOIs
Publication statusPublished - Aug-2015

Keywords

  • aldosterone
  • BAY 94-8862
  • chronic kidney disease
  • diabetic kidney disease
  • diabetic nephropathy
  • finerenone
  • heart failure
  • nonsteroidal mineralocorticoid receptor antagonist
  • CONVERTING ENZYME-INHIBITOR
  • ANGIOTENSIN-ALDOSTERONE SYSTEM
  • MILD PATIENTS HOSPITALIZATION
  • LEFT-VENTRICULAR DYSFUNCTION
  • ACUTE MYOCARDIAL-INFARCTION
  • GLOMERULAR-FILTRATION-RATE
  • WORSENING RENAL-FUNCTION
  • DOUBLE-BLIND
  • EMPHASIS-HF

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