Finerenone in Patients With Chronic Kidney Disease Due to Glomerular Diseases: A Randomized Clinical Trial.
In people with kidney disease caused by glomerular conditions such as IgA nephropathy and FSGS, the drug finerenone slowed loss of kidney function and reduced protein in the urine compared with placebo.
Background
Glomerular diseases are a leading cause of CKD and kidney failure. Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, reduces kidney function loss in CKD, but its effects in CKD due to glomerular disease were uncertain.
Study design
Prespecified exploratory subgroup analysis of a phase 3, randomized, double-blind, placebo-controlled trial across 24 countries in adults with nondiabetic CKD and albuminuria. Of 1584 participants, 903 had investigator-reported glomerular disease (46.1% IgA nephropathy, 23.8% FSGS, 10.0% membranous nephropathy) and received finerenone 10 or 20 mg daily (n=446) or placebo (n=457).
Key findings
Total eGFR slope to 32 months was -3.50 with finerenone vs -4.23 mL/min/1.73 m2 per year with placebo (difference 0.73; 95% CI 0.22-1.24). Albuminuria fell by 42% at month 12, and the composite of kidney failure or sustained ≥40% eGFR decline was lower (7.42 vs 9.60 events per 100 patient-years; HR 0.74, 95% CI 0.57-0.97).
Clinical implications
Although exploratory, the findings suggest finerenone may have an important role in preserving kidney function in patients with glomerular diseases, alongside standard supportive therapy.
Category
Research
Source
JAMA
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