Finerenone in heart failure and chronic kidney disease with type 2 diabetes: FINE-HEART pooled analysis of cardiovascular, kidney and mortality outcomes

Cardiovascular-kidney-metabolic syndrome is an emerging entity that connects cardiovascular diseases, chronic kidney disease and diabetes. The non-steroidal mineralocorticoid receptor antagonist finerenone has been studied in three prospective randomized clinical trials of patients with cardiovascular-kidney-metabolic syndrome: FIDELIO-DKD, FIGARO-DKD and FINEARTS-HF. In light of the strong epidemiological overlap and shared mechanistic drivers of clinical outcomes across cardiovascular-kidney-metabolic syndrome, we summarize the efficacy and safety of finerenone on cardiovascular, kidney and mortality outcomes in this pre-specified participant-level pooled analysis. The three trials included 18,991 participants (mean age 67 ± 10 years; 35% women). During 2.9 years of median follow-up, the primary outcome of cardiovascular death occurred in 421 (4.4%) participants assigned to finerenone and 471 (5.0%) participants assigned to placebo (hazard ratio (HR): 0.89; 95% confidence interval (CI): 0.78-1.01; P = 0.076). Death from any cause occurred in 1,042 (11.0%) participants in the finerenone arm and in 1,136 (12.0%) participants in the placebo arm (HR: 0.91; 95% CI: 0.84-0.99; P = 0.027). Finerenone further reduced the risk of hospitalization from heart failure (HR: 0.83; 95% CI: 0.75-0.92; P < 0.001) and the composite kidney outcome (HR: 0.80; 95% CI: 0.72-0.90; P < 0.001). While in this pooled analysis the reduction in cardiovascular death was not statistically significant, finerenone reduced the risks for deaths of any cause, cardiovascular events and kidney outcomes. PROSPERO identifier: CRD42024570467 .

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Publication Details

Journal
Nature Medicine
Published
2024-09-01
DOI
https://doi.org/10.1038/s41591-024-03264-4
Citations
101
Primary Topic
Hormonal Regulation and Hypertension
Type
article
Field-Weighted Citation Impact
36.13

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article

Finerenone in heart failure and chronic kidney disease with type 2 diabetes: FINE-HEART pooled analysis of cardiovascular, kidney and mortality outcomes

Stefan D. Anker, Sanjiv J. Shah, Brian Lee Claggett, Pardeep S. Jhund et al.
101 citations
Nature Medicine
Hormonal Regulation and Hypertension
36.13
article

Finerenone in heart failure and chronic kidney disease with type 2 diabetes: FINE-HEART pooled analysis of cardiovascular, kidney and mortality outcomes

Stefan D. Anker, Sanjiv J. Shah, Brian Lee Claggett, Pardeep S. Jhund, Gerasimos S Filippatos, James Lay‐Flurrie, John J.V. McMurray, Alasdair Henderson, Faiez M. Zannad, Luís M. Ruilope, Bertram Pitt, Patrick Schloemer, Peter Kolkhof, Meike Brinker, Scott David Solomon, Michele Senni, Muthiah Vaduganathan, Carolyn S.P. Lam, Adriaan A. Voors, Peter R Rossing, Rajiv Agarwal, Akshay S. Desai, Prabhakar Viswanathan
article en
101 citations

Abstract

Cardiovascular-kidney-metabolic syndrome is an emerging entity that connects cardiovascular diseases, chronic kidney disease and diabetes. The non-steroidal mineralocorticoid receptor antagonist finerenone has been studied in three prospective randomized clinical trials of patients with cardiovascular-kidney-metabolic syndrome: FIDELIO-DKD, FIGARO-DKD and FINEARTS-HF. In light of the strong epidemiological overlap and shared mechanistic drivers of clinical outcomes across cardiovascular-kidney-metabolic syndrome, we summarize the efficacy and safety of finerenone on cardiovascular, kidney and mortality outcomes in this pre-specified participant-level pooled analysis. The three trials included 18,991 participants (mean age 67 ± 10 years; 35% women). During 2.9 years of median follow-up, the primary outcome of cardiovascular death occurred in 421 (4.4%) participants assigned to finerenone and 471 (5.0%) participants assigned to placebo (hazard ratio (HR): 0.89; 95% confidence interval (CI): 0.78-1.01; P = 0.076). Death from any cause occurred in 1,042 (11.0%) participants in the finerenone arm and in 1,136 (12.0%) participants in the placebo arm (HR: 0.91; 95% CI: 0.84-0.99; P = 0.027). Finerenone further reduced the risk of hospitalization from heart failure (HR: 0.83; 95% CI: 0.75-0.92; P < 0.001) and the composite kidney outcome (HR: 0.80; 95% CI: 0.72-0.90; P < 0.001). While in this pooled analysis the reduction in cardiovascular death was not statistically significant, finerenone reduced the risks for deaths of any cause, cardiovascular events and kidney outcomes. PROSPERO identifier: CRD42024570467 .

Nature MedicineVol. 30(12)
Northwestern University (US), University of Copenhagen (DK), Brigham and Women's Hospital (US), Steno Diabetes Centers (DK), Harvard University (US), National University of Singapore (SG), University of Groningen (NL), National and Kapodistrian University of Athens (GR), University of Michigan (US), Research Institute Hospital 12 de Octubre (ES), Ospedale Papa Giovanni XXIII (IT), National University Heart Centre Singapore (SG), National Heart Centre Singapore (SG), Indiana University School of Medicine, Indiana University – Purdue University Indianapolis (US), University of Milano-Bicocca (IT), Bayer (Germany) (DE), Charité - Universitätsmedizin Berlin (DE), University of Glasgow (GB), Université de Lorraine (FR)
Bayer
Good health and well-being
Openalex Percentile: Top 0%
Hormonal Regulation and Hypertension
36.13
DOIOpen Access PDFOpenAlex
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