Javed Butler, MD: Consistent Benefits of Finerenone On CV, Kidney Outcomes

New findings suggest finerenone reduced the risk of cardiovascular and kidney outcomes in patients with chronic kidney disease and type 2 diabetes, compared to placebo, regardless of cardiovascular disease (CVD) history.

Moreover, the safety profile of finerenone was shown to be similar between patients with and without a history of atherosclerotic cardiovascular disease (ASCVD).

These findings were presented as feautured clinical research at The American College of Cardiology (ACC) 2022 Scientific Sessions in Washington, DC.

In an interview with HCPLive, Javed Butler, MD, highlighted past and present findings on finerenone, including perspectives on the FIGARO-DKD and FIDELIO-DKD and the FIDELITY analyses.

"The bottom line is that regardless of which one was the primary endpoint or the secondary endpoint, what we learned from these studies was that by the use of finerenone in these patients, you're improving both cardiovascular outcomes, as well as the renal outcomes for these patients," Butler said.

He noted the risk profile escalates for patients with both CKD and ASCVD, but the question remained on whether the benefits of finerenone were limited to patients with CVD or included those without.

Butler noted the FIDELITY trial basically found that it did not matter. Both patients with and without ASCVD benefited regarding CV outcomes with its use.

"The practical implication is that when somebody meets the criteria of the patients that were tested in these trials, don't wait for this therapy," he said. "If you start early, you will prevent it primary prevention. If somebody already has ASCVD, you will prevent recurrent events in those patients."

He additionally spoke to the safety profile of the agent, noting a lower incidence of hyperkalemia-related incidence of treatment discontinuation. Determining potassium level to initate or stop the dose are important, but the overall benefit outweights the risk.

Butler noted that upcoming studies may focus on combination therapy in DKD, similar to advancements in heart failure treatment. As well, Butler questioned if finerenone would show the same benefit in patients with non-diabetic CKD.

"On one hand we have to, you know, generate evidence of what to treat patients with and what outcomes to expect," Butler said. "The other is the evidence implementation and unfortunately, the scientific enterprise is very good at evidence generation, but we need to work on the science of how to implement these therapies in appropriate patients. The longer we take in implementing these therapies, the longer we put our patients at high risk."