Finerenone represents a significant advancement in treating specific types of heart failure. This non-steroidal mineralocorticoid receptor antagonist offers a new approach to managing a condition that affects millions. Its development addresses challenges in providing effective therapies for heart failure patients.
Understanding Heart Failure Finerenone Targets
Heart failure is a complex condition where the heart cannot pump enough blood. It is classified by the left ventricular ejection fraction (LVEF), which measures the percentage of blood pumped out with each beat.
Finerenone primarily targets Heart Failure with Preserved Ejection Fraction (HFpEF) and Heart Failure with Mildly Reduced Ejection Fraction (HFmrEF). In HFpEF, the LVEF is 50% or higher, meaning the heart struggles to relax and fill properly despite normal pumping. HFmrEF is characterized by an LVEF between 41% and 49%, representing a middle ground where pumping function is neither clearly preserved nor significantly reduced.
Treating HFpEF and HFmrEF has been particularly challenging, with limited options compared to heart failure with reduced ejection fraction (HFrEF), where the LVEF is 40% or less. Finerenone’s introduction offers a new therapeutic pathway for these patient populations.
Finerenone: How It Works to Improve Heart Health
Finerenone operates as a non-steroidal mineralocorticoid receptor (MR) antagonist. It blocks mineralocorticoid receptors, proteins found in various tissues, including the heart and kidneys. Overactivation of these receptors by the hormone aldosterone can lead to inflammation and fibrosis (scarring), contributing to heart and kidney disease progression.
Unlike older, steroidal MR antagonists such as spironolactone and eplerenone, finerenone has a distinct chemical structure. Its non-steroidal design allows it to selectively bind to the mineralocorticoid receptor with high affinity, minimizing off-target effects. This contributes to a more balanced distribution within the body, affecting both the kidneys and the heart more equally.
By blocking the mineralocorticoid receptor, finerenone helps reduce the harmful effects of aldosterone. This action counteracts inflammation and fibrosis in the heart and kidneys, protecting these organs from further damage. This targeted approach helps prevent adverse cardiac remodeling and can lead to improved outcomes in individuals with heart failure.
Clinical Successes and Patient Impact
The effectiveness of finerenone in heart failure is supported by the FINEARTS-HF study. This large, randomized, double-blind, placebo-controlled trial evaluated finerenone in patients with symptomatic heart failure who had an LVEF of 40% or greater, including those with HFpEF and HFmrEF.
The FINEARTS-HF trial assessed the composite outcome of cardiovascular death and total heart failure events, including hospitalizations. Results showed a statistically significant 16% relative risk reduction in this composite endpoint for patients receiving finerenone compared to placebo.
These findings indicate finerenone can significantly reduce the risk of cardiovascular death and recurrent heart failure events, offering a meaningful improvement in patient prognosis. The trial also demonstrated consistent efficacy across the entire LVEF spectrum studied, as well as across different age groups and sexes. This positive outcome positions finerenone as a new therapeutic option for managing heart failure with preserved or mildly reduced ejection fraction.
Important Considerations for Treatment
Finerenone is a prescription medication requiring careful medical guidance. It is approved for adults with heart failure with a left ventricular ejection fraction of 40% or greater. The drug was also initially approved for chronic kidney disease associated with type 2 diabetes, and its benefits extend to reducing heart failure events in this patient group.
A primary consideration with finerenone is the potential for increased blood potassium levels, known as hyperkalemia. Healthcare providers monitor potassium levels regularly, especially when starting or adjusting the dosage. Hyperkalemia can cause muscle weakness or fatigue, and severe cases may affect heart rhythm.
Other potential side effects include low blood pressure, which can cause dizziness, and changes in kidney function test results. Patients should inform their doctor about all medications, as some drugs can interact with finerenone and increase hyperkalemia risk. A healthcare professional determines the appropriate dose based on kidney function and potassium levels.