On 31 August, at the 75th European Society of Cardiology (ESC) conference, during a late-breaking clinical science session on the topic of ‘Biomarker’, Dr Mario Berger presented findings from the biomarker study FINEARTS-BM, a proteomics study. Berger focused on Bayer’s Kerendia (finerenone) to highlight mechanistic insights from the FINEARTS-HF trial.
The findings presented at the ESC showed that in heart failure (HF) patients with left ventricular ejection fraction of equal to or greater than 40%, finerenone modulates not only renin-angiotensin-aldosterone system (RAAS) effector proteins but also seems to impact various proteins of the extracellular matrix (ECM). Pathway analysis confirmed that treatment-responsive markers are enriched in remodelling and fibrosis-associated pathways. Berger also highlighted that circulating levels of the ECM proteins collagen triple helix repeat containing 1 and chondroitin sulfate proteoglycan 4 are downregulated with finerenone. Lower levels of these proteins are associated with lower cardiovascular risk.
These findings are significant; unlike traditional mineralocorticoid receptor antagonists (MRAs), finerenone exhibits a dual mechanism of action – it not only blocks RAAS effector proteins but potentially modulates extracellular matrix proteins involved in cardiac remodelling. This broader mechanism helps explain finerenone’s superior cardiovascular outcomes compared to steroidal MRAs like spironolactone and eplerenone. This mechanistic evidence supports finerenone’s clinical efficacy demonstrated in the FINEARTS-HF trial, where it reduced heart failure events and cardiovascular death by 16% in patients with heart failure with preserved ejection fraction and heart failure with mid-range ejection fraction. The FINEARTS-HF results led to US Food and Drug Administration approval in July 2025 for treating adults with heart failure and left ventricular ejection fraction of equal to or greater than 40%, addressing a significant unmet medical need in a population with limited effective treatment options and high hospitalisation rates.
Finerenone is a nonsteroidal MRA. Compared to steroidal MRAs, finerenone has a shorter half-life, and has a more balanced distribution between the heart and the kidney. A key opinion leader interviewed by leading data and analytics company GlobalData states: “Evidence suggest that the risk of hyperkalaemia is lower with finerenone than with, for example, eplerenone therefore, I think it has potential advantages”.