Early reduction in albuminuria by finerenone accounts for “a large proportion of the treatment effect against CKD progression and a modest proportion of the effect against cardiovascular outcomes” in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D), an analysis shows. Finerenone is a nonsteroidal mineralocorticoid receptor antagonist that reduces cardiovascular and kidney failure outcomes and lowers the urine albumin-to-creatinine ratio (UACR).
In a post hoc mediation analysis of pooled data from a pair of phase 3 trials, data for 12,512 patients with CKD and T2D showed the following: “At baseline, median UACR was 514 mg/g. A 30% or greater reduction in UACR was seen in 3,338 (53.2%) patients in the finerenone group and 1,684 (27.0%) patients in the placebo group. Reduction in UACR (analyzed as a continuous variable) mediated 84% and 37% of the treatment effect on the kidney and cardiovascular outcomes, respectively. When change in UACR was analyzed as a binary variable (that is, whether the guideline-recommended 30% reduction threshold was met), the proportions mediated for each outcome were 64% and 26%, respectively.”