Finerenone in CKD: Randomized Trial Findings

Key Takeaways

• Finerenone was associated with a slower total eGFR decline, lower albuminuria, and a lower composite kidney-event rate than placebo in this subgroup.
• The subgroup comprised 903 of 1,584 participants with investigator-reported glomerular disease, most often IgA nephropathy 416 (46.1%), focal segmental glomerulosclerosis 215 (23.8%), and membranous nephropathy 90 (10.0%).
• This was a prespecified exploratory subgroup analysis within the parent phase 3 trial, and the available record does not provide a detailed adverse-event breakdown.

Finerenone was associated with a 42% reduction in albuminuria at 12 months among participants with investigator-reported glomerular disease in a larger randomized trial. This prespecified exploratory subgroup, which accounted for more than half of overall enrollment, was drawn from a prespecified exploratory subgroup analysis. Kidney function decline also appeared less steep with finerenone than with placebo over follow-up.

This phase 3, randomized, double-blind, placebo-controlled trial was conducted across 24 countries and regions and enrolled adults with nondiabetic CKD. Eligibility required either eGFR 25 to less than 60 with UACR 200 to less than 500, or eGFR 25 to less than 90 with UACR 500 to less than 3500. Among 1,584 enrollees, 903 participants, or 57.0%, had glomerular disease, most often IgA nephropathy, 416 cases, focal segmental glomerulosclerosis, 215 cases, and membranous nephropathy, 90 cases. Baseline characteristics included a mean age of 51.1 years, 40.1% female, 61.9% Asian, mean eGFR 48.8, and median UACR 839.6 mg/g.

In the glomerular disease subgroup, finerenone 10 mg or 20 mg once daily was compared with matching placebo. From baseline to month 32, total eGFR slope was -3.50 with finerenone and -4.23 with placebo, a between-group difference of 0.73 and 95% CI 0.22 to 1.24. Albuminuria was 42% lower at month 12 with finerenone, with a 95% CI ranging from 35% to 48%. The composite endpoint of kidney failure or sustained 40% or more eGFR decline occurred at 7.42 versus 9.60 events per 100 patient-years. That translated to a hazard ratio of 0.74, with a 95% CI of 0.57 to 0.97.