Finerenone – a novel, nonsteroidal, selective mineralocorticoid receptor antagonist – may reduce cardiovascular outcomes among patients with chronic kidney disease and Type 2 diabetes, according to results from the FIDELIO-DKD trial presented Nov. 16 during AHA 2020 and simultaneously published in Circulation.

Gerasimos Filippatos, MD, et al., looked at 5,674 patients (average age 66; 70.2% male) at more than 900 sites in 48 countries. Patients were randomized to receive a daily dose of finerenone (10 mg or 20 mg) or placebo and were followed for a median of 2.6 years.

Results showed that the incidence of the cardiovascular composite outcome – including time to cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure – was "significantly lower" in the finerenone group vs. the placebo group (367 [13.0%] and 420 [14.8%] patients, respectively; incidence rates per 100 patient-years, 5.11 and 5.92, respectively; HR, 0.86; 95% CI, 0.75–0.99; P=0.034). The authors explain that "this benefit was consistent in patients with or without a history of cardiovascular disease at baseline."

In addition, patients treated with finerenone had a lower incidence of the individual components of cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure compared with placebo; however, incidence of nonfatal stroke was similar.

The authors conclude that their "results suggest that finerenone may represent an important treatment advance to reduce cardiovascular morbidity and mortality in patients with chronic kidney disease and Type 2 Diabetes."

Clinical Topics: Diabetes and Cardiometabolic Disease

Keywords: AHA Annual Scientific Sessions, AHA20, Metabolic Syndrome, Diabetes Mellitus, Type 2, Renal Insufficiency, Chronic

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