Effectiveness and Safety of Finerenone in Patients with IgAN

Background: IgA nephropathy (IgAN) is the most common form of glomerulonephritis, with no standardized treatment regimen currently established. This study aimed to evaluate the efficacy and safety of finerenone in combination with an ACEI/ARB regimen in patients with IgAN. Methods: This study included 45 patients with primary IgAN. Patients were divided into two groups: those receiving finerenone combined with an ACEI/ARB, and those receiving an ACEI/ARB alone. The primary endpoint was treatment response, assessed by changes in UPCR and eGFR from baseline to 6 months. Clinical data from both groups were analyzed statistically. Results: At 6 months, the percentage change in UPCR was significantly greater in the finerenone plus ACEI/ARB group compared with the ACEI/ARB group alone (-41.01% [IQR, -53.72%, -21.76%] vs. -21.26% [IQR, -39.85%, -6.76%]; P = 0.046). The absolute UPCR was also significantly lower (0.42 [IQR, 0.30, 0.72] vs. 0.66 [IQR, 0.46, 1.18]; P = 0.039). No significant differences in eGFR were observed between the groups. The response rate was significantly higher in the finerenone group than in the ACEI/ARB group (68.75% vs. 37.93%; P = 0.048). Serum ALB levels were also higher in the finerenone group (45.2 ± 2.4 g/L vs. 43.1 ± 3.2 g/L; P = 0.031). No serious adverse events were reported. Conclusion: Finerenone combined with an ACEI/ARB regimen significantly reduced proteinuria and increased serum albumin levels in patients with IgAN, with no serious adverse events observed. Funding: Other NIH Support - The Youth Foundation of Shandong Natural Science Foundation (ZR2023QH239),and the ECCM Program of the Clinical Research Center of Shandong University (No. 2021SDUCRCB007)Figure1.Flow chart of the trial.Trends of the percent change of UPCR (A), UPCR (B), and ALB (C) following the initiation of ACEI/ARB or finerenone +ACEI/ARB treatment. *P＜0.05