Non-steroidal mineralocorticoid receptor antagonism for the treatment of cardiovascular and renal disease

Pharmaceutical antagonism of the mineralocorticoid receptor (MR) can protect against organ damage caused by elevated aldosterone levels in patients experiencing heart failure (HF), chronic kidney disease (CKD), primary aldosteronism, and hypertension. While traditional steroid‐based MR antagonists e...

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Bibliographic Details
Published in:European journal of heart failure 2016-01, Vol.18 (1), p.28-37
Main Authors: Bramlage, Peter, Swift, Stephanie L., Thoenes, Martin, Minguet, Joan, Ferrero, Carmen, Schmieder, Roland E.
Format: Article
Language:English
Subjects:
Antagonist
ARTS
BAY 94-8862
Clinical Trials as Topic
Disease
Failure
Finerenone
Heart
Heart Failure - drug therapy
Heart Failure - metabolism
Humans
Hypertension - drug therapy
Hypertension - metabolism
Kidney
Mineralocorticoid
Mineralocorticoid Receptor Antagonists - pharmacology
Naphthyridines - pharmacology
Receptor
Renal Insufficiency, Chronic - drug therapy
Renal Insufficiency, Chronic - metabolism
Treatment Outcome
Water-Electrolyte Balance - drug effects
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Description
Summary:Pharmaceutical antagonism of the mineralocorticoid receptor (MR) can protect against organ damage caused by elevated aldosterone levels in patients experiencing heart failure (HF), chronic kidney disease (CKD), primary aldosteronism, and hypertension. While traditional steroid‐based MR antagonists effectively reduce mortality rates and extend patient survival, their broad application has been limited by significant side effects, most notably hyperkalaemia. Recently, finerenone (BAY 94‐8862) has emerged as a next‐generation non‐steroidal dihydropyridine‐based MR antagonist designed to minimize off‐target effects while maintaining potent efficacy. In this review, the outcomes of finerenone therapy in several diseases associated with MR activity are explored. The (pre‐) clinical efficacy of finerenone is compared with that of traditional steroid‐based MR antagonists. Finally, recent and ongoing clinical trials using finerenone to treat chronic HF, CKD, and diabetic nephropathy are discussed. Taken together, pre‐clinical and clinical evidence suggests that finerenone may achieve equivalent organ‐protective effects with reduced levels of electrolyte disturbance compared with traditional steroid‐based MR antagonists. This supports further clinical development of finerenone for the treatment of cardiovascular and renal disease.
ISSN:1388-9842
1879-0844
DOI:10.1002/ejhf.444