Finerenone works by quickly lowering albuminuria, analysis finds
Reductions in the urine albumin-to-creatinine ratio within four months were responsible for 84% of the treatment effect of finerenone on kidney outcomes and 37% of that on cardiovascular outcomes, according to an industry-funded four-year analysis of trials in patients with chronic kidney disease and type 2 diabetes.
In patients with chronic kidney disease (CKD) and type 2 diabetes, most of the effect of finerenone on the kidneys comes from reductions in albuminuria, a new analysis found.
The study used pooled data from two phase 3, double-blind trials of finerenone that included 12,512 patients with CKD and type 2 diabetes in 48 countries. The goal was to quantify the proportion of kidney and cardiovascular risk reductions seen over a four-year period that were mediated by the change in log urine albumin-to-creatinine ratio (UACR) during the first four months of therapy. Results of the study, which was funded by Bayer AG, were published by Annals of Internal Medicine on Dec. 5.
At baseline, patients' median UACR was 514 mg/g; significantly more patients in the finerenone group than the placebo group achieved a 30% or greater reduction in UACR (53.2% vs. 27.0%). As a continuous variable, reduction in UACR mediated 84% of the treatment effect on the kidney (kidney failure, sustained 57% decrease in estimated glomerular filtration rate from baseline, or death from kidney disease) compared to 37% of the effect on cardiovascular outcomes (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or heart failure hospitalization). As a binary variable, the proportions were 64% and 26%, respectively.
The results of the analysis “provide strong evidence supporting the American Diabetes Association's ‘Standards of Care in Diabetes—2023’ guideline recommendation indicating a UACR reduction of 30% or greater as a therapeutic target for patients who have UACR of 300 mg/g or greater,” as well as indicating that such a target may also be beneficial to reduce cardiovascular risk, said the study authors. They noted that the results also highlight the importance of monitoring UACR after initiating finerenone, “as it can serve as a valuable surrogate indicator of the early treatment efficacy and offer insights into potential long-term kidney and cardiovascular benefits.”