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Mineralocorticoid Receptor Antagonists: a Comprehensive Review of Finerenone

  • New Therapies for Cardiovascular Disease (AA Bavry, Section Editor)
  • Published:
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Abstract

Purpose of Review

We aim to review the mechanism of action and safety profile of mineralocorticoid receptor antagonists (MRAs) and discuss the differences between selective and non-selective MRAs. More specifically, finerenone is a new medication that is currently under investigation for its promising cardiovascular and nephrological effects.

Recent Findings

MRAs are well known for their utility in treating heart failure, refractory hypertension, and diverse nephropathies, namely, diabetic nephropathy. As their name denotes, MRAs inhibit the action of aldosterone at the mineralocorticoid receptor, preventing receptor activation. This prevents remodeling, decreases inflammation, and improves proteinuria. There are not significant differences in outcomes between selective and non-selective MRAs. A new selective MRA named finerenone (originally BAY 94-8862) has shown promising results in several trials (ARTS-HF and ARTS-DN) and smaller studies. Finerenone may have a dose-dependent benefit over older MRAs, decreasing rates of albuminuria and levels of BNP and NT-ProBNP without causing a significant increase in serum potassium levels. This medication is not yet approved as it is still in phase 3 clinical trials (FIGARO-DKD and FIDELIO-DKD trials).

Summary

MRAs are beneficial in several disease states. Newer medications, such as finerenone, should be considered in patients with heart failure and diabetic nephropathy who may benefit from a reduction in albuminuria and BNP/NT-ProBNP. Data surrounding finerenone are limited to date. However, results from ongoing clinical trials, as well as new trials to evaluate use in other pathologies, could validate the implementation of this medication in daily practice.

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Acknowledgments

We thank Jose A. Velez, MD (nephrologist) for his guidance and detailed explanation on the current evidence available for the management of proteinuria using mineralocorticoid receptor antagonists.

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Authors and Affiliations

  1. Department of Medicine, Division of Internal Medicine, University of Texas Health San Antonio, San Antonio, TX, 78229, USA

    Juan Simon Rico-Mesa, Averi White & Ashkan Ahmadian-Tehrani

  2. Department of Medicine, Division of Cardiovascular Diseases, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7872, San Antonio, TX, 78229, USA

    Allen S. Anderson

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  1. Juan Simon Rico-Mesa
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Correspondence to Allen S. Anderson.

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Dr. Rico-Mesa, White, and Ahmadian-Tehrani have nothing to disclose.

Dr. Anderson has received honoraria from Novartis and Pfizer. He is also a consultant for Edwards LifeSciences and received research support from Abbott.

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Rico-Mesa, J.S., White, A., Ahmadian-Tehrani, A. et al. Mineralocorticoid Receptor Antagonists: a Comprehensive Review of Finerenone. Curr Cardiol Rep 22, 140 (2020). https://doi.org/10.1007/s11886-020-01399-7

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