Utilization of Finerenone by Patients With T2D, CKD

Finerenone is a nonsteroidal mineralocorticoid receptor antagonist approved for use in adults with type 2 diabetes (T2D) and chronic kidney disease (CKD) to reduce the risk of sustained estimated glomerular filtration rate (eGFR) decline, end-stage renal disease (ESRD), cardiovascular death, nonfatal myocardial infarction, and hospitalization due to heart failure. Two years after its approval, researchers led by Ajay Singh studied the drug’s utilization. They presented results at the National Kidney Foundation Spring Clinical Meetings.

Their observational, cross-sectional study examined patients who were prescribed finerenone between August 2021 and September 2023 and had 12 months of electronic health record activity prior to their first prescription date (index). Patient data came from practices across all 50 states and nearly 15% of US ambulatory care centers.

The study included 20,535 patients; mean age was 68 years, 44.3% were female, and 44.8% were White. Of patients with both eGFR and urine albumin-to-creatinine ratio lab results (n=4320), 71.1% had values that fell into the categories of high risk or very high risk according to Kidney Disease Improving Global Outcomes (KDIGO) standards. The percentage of patients with prescriptions for sodium-glucose cotransporter inhibitors, glucagon-like peptide-1 receptor agonists, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers was 40.5%, 29.0%, 23.7%, and 38.4%, respectively.

The proportion of patients prescribed finerenone by primary care physicians, nephrologists, endocrinologists, and cardiologists was 40.9%, 17.4%, 10.7%, and 8.8%, respectively; 82.8% received an initial dose of 10 mg. Despite being recommended by KDIGO and the American Diabetes Association, finerenone was highly underutilized, with the lowest utilization in the Midwest. The study authors believe future studies “should compare CKD in T2D patients with versus without finerenone, as well as associated outcomes.”

Source: Singh A, Singh R, Du Y, et al. Utilization of nonsteroidal MRA finerenone: evaluation of real-world data in the United States, 2021-2023. Presented at the National Kidney Foundation Spring Clinical Meetings 2024; May 14-18, 2024; Long Beach, California.