title: Non-steroidal mineralocorticoid receptor antagonism for the treatment of cardiovascular and renal disease.
abstract: 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.
authors.affiliation: Institute for Pharmacology and Preventive Medicine, Mahlow, Germany.|Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Sevilla, Spain.
authors.forename: Peter
authors.initials: P
authors.lastname: Bramlage
authors.affiliation: Institute for Pharmacology and Preventive Medicine, Mahlow, Germany.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Swift
authors.affiliation: Léman Research Institute, Oberägeri, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Thoenes
authors.affiliation: Institute for Pharmacology and Preventive Medicine, Mahlow, Germany.
authors.forename: Joan
authors.initials: J
authors.lastname: Minguet
authors.affiliation: Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Sevilla, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Ferrero
authors.affiliation: Department of Nephrology and Hypertension, University Hospital of the University Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
mesh_terms: D002986:Clinical Trials as Topic; D006333:Heart Failure / Q000188:drug therapy / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000378:metabolism; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology; D009287:Naphthyridines / Q000494:pharmacology*; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy / Q000378:metabolism; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000187:drug effects*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D009287:Naphthyridines; C576501:finerenone
keywords: ARTS; Antagonist; BAY 94-8862; Disease; Failure; Finerenone; Heart; Kidney; Mineralocorticoid; Receptor