Finerenone
Finerenone, marketed under the brand name Kerendia among others, is a medication used to reduce the risk of kidney function decline, kidney failure, cardiovascular death, non-fatal heart attacks, and hospitalization for heart failure in adults with chronic kidney disease associated with type2 diabetes. Finerenone is a non-steroidal mineralocorticoid receptor antagonist. It is taken orally.
Common side effects include abnormally high levels of potassium in the bloodstream, abnormally low levels of sodium in the bloodstream, and abnormally low blood pressure.
Finerenone was approved for medical use in the United States in July 2021, and in the European Union in February 2022. The US Food and Drug Administration considers it to be a first-in-class medication.
Medical uses
In the United States, finerenone is indicated to reduce the risk of kidney function decline, kidney failure, cardiovascular death, non-fatal heart attacks, and hospitalization for heart failure in adults with chronic kidney disease associated with type2 diabetes.In the European Union, finerenone is indicated for the treatment of chronic kidney disease associated with type2 diabetes in adults.
Pharmacology
Finerenone has less relative affinity to other steroid hormone receptors than currently available aldosterone antagonists such as eplerenone and spironolactone, which should result in fewer adverse effects like gynaecomastia, impotence, and low libido.This table compares inhibitory concentrations of three antimineralocorticoids. Mineralocorticoid receptor inhibition is responsible for the desired action of the drugs, whereas inhibition of the other receptors potentially leads to side effects. Lower values mean stronger inhibition.
| Spironolactone | Eplerenone | Finerenone | |
| Mineralocorticoid receptor | 24 | 990 | 18 |
| Glucocorticoid receptor | 2400 | 22,000 | >10,000 |
| Androgen receptor | 77 | 21,200 | >10,000 |
| Progesterone receptor | 740 | 31,200 | >10,000 |
Finerenone acts as an antagonist to mineralocorticoid receptors harboring the S810L mutation, unlike other traditional inhibitors of mineralocorticoids such as spironolactone and eplerenone that incidentally act as agonists.
A meta-analysis of data from seven randomized controlled trials found a benefit to using finerenone in people with diabetic kidney disease and overt proteinuria.
Adverse effects
Finerenone may cause electrolyte imbalances. Symptoms that correlate with higher levels of potassium include nausea, weakness, chest pain, and loss of movement. People with lower levels of sodium may experience headaches, confusion, weakness, and feeling off balance.History
The efficacy of finerenone to improve kidney and heart outcomes was evaluated in a randomized, multicenter, double-blind, placebo-controlled study in adults with chronic kidney disease associated with type2 diabetes. In this study, 5,674 participants were randomly assigned to receive either finerenone or a placebo.The study compared the two groups for the number of participants whose disease progressed to a composite endpoint that included at least a 40% reduction in kidney function, progression to kidney failure, or kidney death. Results showed that 504 of the 2,833 participants who received finerenone had at least one of the events in the composite endpoint compared to 600 of the 2,841 participants who received a placebo.
The US Food and Drug Administration granted the application for finerenone priority review and fast track designations. The FDA granted the approval of Kerendia to Bayer Healthcare.