Heart Failure Reviews

, Volume 24, Issue 5, pp 637–646 | Cite as

Comparative efficacy and safety of mineralocorticoid receptor antagonists in heart failure: a network meta-analysis of randomized controlled trials

  • Pingping Yang
  • Wen Shen
  • Xi Chen
  • Dan Zhu
  • Xiuxiu Xu
  • Tao Wu
  • Gaosi Xu
  • Qinghua WuEmail author


The efficacy and safety of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure (HF) are controversial. To explore the role of MRAs in HF patients with an ejection fraction of no more than 45%, we conducted a network meta-analysis of randomized controlled trials (RCTs). We systematically searched PubMed, Embase, the Cochrane Library, and Clinicaltrials. RCTs involving the efficacy and/or safety of the use of MRAs in patients with HF were included. Outputs are presented as the surface under the cumulative ranking area (SUCRA) probabilities. Thirteen RCTs involving a total of 13,597 participants were included. Finerenone 10 mg was associated with the lowest probability of achieving at cardiovascular mortality (SUCRA, 5.0%), followed by finerenone 7.5 mg (SUCRA, 31.6%). In reducing N-terminal pro-B-type natriuretic peptide, finerenone 15 mg and finerenone 7.5 mg ranked the best and second best (SUCRA 68.1% and 63.8%, respectively), followed by finerenone 10 mg (SUCRA 59.2%). Spironolactone and canrenone have a higher risk of hyperkalemia and renal deterioration. Regarding the prevention of worsening renal function, finerenone 7.5 mg (SUCRA 14.3%) was the best treatment, followed by finerenone 2.5 mg (SUCRA 16.3%) and finerenone 10 mg (SUCRA 25.6%). Compared with spironolactone and eplerenone, finerenone 10 mg was associated with low risk in the occurrence of cardiovascular mortality, hospitalization, and adverse events (P < 0.01). This network meta-analysis is the first to find that finerenone 7.5–10 mg has the highest probability of being the optimal alternative among MRAs in the treatment of HF patients with an ejection fraction of no more than 45%.


Heart failure Mineralocorticoid receptor antagonists Hyperkalemia Meta-analysis 



This work was supported by the Provincial Plans—Social Development Areas—Major Projects of Jiangxi Province (No. 20161ACG70012) and the “5511” Innovative Drivers for Talent Teams of Jiangxi Province (No. 20165BCB18018).

Author contributions

Y-PP and S-W performed the meta-analysis; C-X, ZH-D, and X-XX were responsible for the statistical analysis; W-T and X-GS provided editing assistance; and W-QH prepared the manuscript. All authors have reviewed and agreed to this information before submission.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not required.

Supplementary material

10741_2019_9790_MOESM1_ESM.doc (11.1 mb)
ESM 1 (DOC 11335 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Pingping Yang
    • 1
  • Wen Shen
    • 1
  • Xi Chen
    • 2
  • Dan Zhu
    • 1
  • Xiuxiu Xu
    • 1
  • Tao Wu
    • 1
  • Gaosi Xu
    • 3
  • Qinghua Wu
    • 1
    Email author
  1. 1.Department of Cardiovascular MedicineThe Second Affiliated Hospital of Nanchang UniversityNanchangPeople’s Republic of China
  2. 2.Department of Neurology, Huashan HospitalFudan UniversityShanghaiChina
  3. 3.Department of NephrologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina

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