Finerenone Safely Reduces Diuretic Use in Patients With Heart Failure

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Finerenone was safe and efficacious across diuretic use in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) and reduced diuretic use.1

“Because finerenone has effects on sodium, potassium, and water excretion, the aim of this prespecified analysis of FINEARTS-HF was to evaluate the efficacy and tolerability of finerenone in relation to background diuretic therapy, including effects on biomarkers reflecting volume status and kidney function.2 We hypothesized that finereneone would have a diuretic-sparing effect in patients with HFmrEF/HFpEF,” study investigator Misato Chimura, MD, PhD, British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom, and Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan, and colleagues wrote.1

These findings are from a prespecified secondary analysis of the FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure) randomized clinical trial. FINEARTS-HF was conducted across 653 sites in 37 countries and included adults aged 40 years and older with HFmrEF/HFpEF, who were randomized between September 2020 and January 2023. Chimura and colleagues compared the composite of total HF events and cardiovascular death between patients receiving finerenone (titrated to 20 mg or 40 mg) or placebo according to the following baseline diuretic categories: only a nonloop diuretic (thiazide or thiazide-like); loop diuretic (≤40 mg vs >40 mg furosemide-equivalent dose); and combined nonloop and loop diuretic use. Investigators conducted data analysis was conducted from December 1, 2024, to January 30, 2025.

The analysis included 5438 participants, 2496 (45.9%) of which were female, with a mean age of 72.1 (SD, 9.6) years. A total of 684 patients (12.6%) were receiving a nonloop diuretic, 3040 (55.9%) less than or equal to 40 mg furosemide equivalent, 1145 (21.1%) 40 mg or greater furosemide equivalent, and 569 (10.5%) both nonloop and loop diuretics.

Chimura and colleagues found that compared with placebo, finerenone reduced the risk of the primary end point across all diuretic subgroups. Specifically, patients in the nonloop had a rate ratio of 0.84 (95% CI, 0.47-1.51), those in the 40 mg or less loop had a rate ratio of 0.86 (95% CI, 0.72-1.02), the more than 40 mg loop had a rate ratio of 0.98 (95% CI, 0.78-1.24), and the combined nonloop and loop categories had a rate ratio of 0.54 (95% CI, 0.35-0.83; P for interaction = .18).

Notably, patients randomized to finerenone were less likely to experience a dose increase compared to placebo (6 months: 7.4% vs 9.5%; P = .007; 12 months: 10.0% vs 13.9%; P < .001; 18 months: 12.0% vs 16.6%; P < .001) and more likely to experience a dose decrease or discontinuation (6 months: 15.0% vs 9.3%; P < .001; 12 months: 18.0% vs 11.6%; P < .001; 18 months: 19.9% vs 13.6%; P < .001). However, there was no significant difference in initiation between the randomized treatment groups (HR, 0.98; 95% CI, 0.71-1.36; P = .91).

Safety was consistent across diuretic categories. Finerenone increased the incidence of hypotension and hyperkalemia (potassium >5.5 mEq/L) and reduced the risk of hypokalemia across all diuretic categories compared with placebo.

“In this prespecified analysis of the FINEARTS-HF randomized clinical trial, the benefits of finerenone were consistent across all diuretic subgroups. Compared to placebo, finerenone did not significantly reduce the initiation of a loop diuretic in patients not taking loop diuretics at baseline; however, finerenone reduced the need foeer loop diuretic dose intensification and led to a decrease in the mean loop diuretic dose. Initiating finerenone therapy may facilitate a reduction in loop diuretic requirements,” Chimura and colleagues concluded.1

REFERENCES
  1. Chimura M, Jhund PS, Henderson AD, et al. Efficacy and Tolerability of Finerenone According to the Use and Dosage of Diuretics: A Prespecified Analysis of the FINEARTS-HF Randomized Clinical Trial. JAMA Cardiol. Published online August 13, 2025. doi:10.1001/jamacardio.2025.2551
  2. Pradhan A, Tripathi UC. Finerenone: a breakthrough mineralocorticoid receptor antagonist for heart failure, diabetes and chronic kidney disease. The Egyptian Heart Journal. 2024;76(1). doi: 10.1186/s43044-024-00586-z

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