Bayer’s FINEARTS-HF study revealed that finerenone could be poised to become the next big heart failure treatment at ESC 2024, and a new series of JACC sub-studies just further strengthened its case.
- FINEARTS-HF explored the effects of finerenone in ~6k HFmrEF/HFpEF patients and found that the drug significantly reduced worsening HF events and CV death versus placebo.
- Finerenone (Bayer’s Kerendia) got its start with CKD, and is the first mineralocorticoid receptor antagonist to be used for HF.
The first of the featured studies revealed that patients treated soon after experiencing a worsening heart failure (WHF) event saw greater benefits.
- Finerenone lowered the risk of CV events most in patients enrolled within one week (RR: 0.74) or three months of WHF (RR: 0.79).
The second sub-study discovered that finerenone reduced HF events and improved patient health, regardless of baseline KCCQ score.
- Finerenone reduced the risk of CV death and WHF events across all KCCQ ranges from scores of 0-<57 (RR: 0.82), to 57-<81 (0.88), and 81-100 (0.88).
- The drug also significantly improved KCCQ from baseline by an average of 1.62 points at 12 months.
Finerenone proved effective regardless of baseline bodyweight, reducing CV death and WHF events across all BMI groups (underweight/normal, rate ratio: 0.80; overweight: 0.91; obesity class I: 0.92; obesity class II-III: 0.67).
Despite the strong benefits, finerenone was not without its side effects, as the fourth and fifth sub-studies found that the drug led to a mild initial decline in eGFR, although it wasn’t significant enough to warrant stopping treatment.
- Nearly a quarter of finerenone patients experienced a ≥15% decline in eGFR compared to 13.4% on placebo.
- Notably, eGFR decline was associated with higher risk of CV death and HF events in patients on placebo but not in those on finerenone (aRR: 1.07 vs. 1.50).
The Takeaway
After an impressive primary study and several supportive sub-studies, all signs seem to be pointing in the direction of finerenone as a frontline HF treatment. That’s pretty big considering how relatively empty the HF pharmaceutical space was a decade ago.
