TOPLINE:
Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, demonstrated consistent efficacy and safety regardless of diuretic type or dose and reduced overall diuretic requirements in patients with heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), although it had no effect on the initiation of a new loop diuretic.
METHODOLOGY:
- Investigators conducted a secondary analysis of the multinational FINEARTS-HF trial to evaluate the efficacy and tolerability of finerenone in patients with HFmrEF/HFpEF who were on diuretics.
- The analysis included 5438 patients (mean age, 72.1 years; 45.9% women) who had HF classified as New York Heart Association class II through IV, used diuretics within 30 days of randomization, had a left ventricular ejection fraction of 40% or more with evidence of structural heart disease, and had elevated levels of natriuretic peptide.
- Patients were randomly assigned to receive either finerenone (titrated to 20 mg or 40 mg daily) or a matching placebo.
- Baseline use of diuretics was categorized as the use of only nonloop diuretics, only loop diuretics at ≤ 40 mg/d furosemide equivalent, only loop diuretics at a > 40 mg/d furosemide equivalent, or a combination of both loop and nonloop diuretics.
- The primary outcome was a composite of total HF events and cardiovascular death.
TAKEAWAY:
- At baseline, 12.6% of patients were receiving nonloop diuretics, 55.9% were receiving ≤ 40 mg and 21.1% were receiving > 40 mg of furosemide-equivalent loop diuretics, and 10.5% were receiving both nonloop and loop diuretics.
- The reduction in the risk for the primary outcome with finerenone vs placebo was consistent across all diuretic types and loop diuretic doses.
- At 6, 12, or 18 months, patients treated with finerenone vs placebo were less likely to experience an increase in diuretic dose (P < .01 for all) and more likely to have their dose reduced or discontinued (P < .001 for all); however, the initiation of a loop diuretic remained unaffected.
- The safety profile remained consistent across all diuretic categories.
IN PRACTICE:
“In this prespecified analysis of the FINEARTS-HF randomized clinical trial, the benefits of finerenone were consistent across all diuretic subgroups,” the researchers reported. “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 for 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.”
SOURCE:
This study was led by Misato Chimura, MD, PhD, of the University of Glasgow in Glasgow, Scotland. It was published online on August 13, 2025, in JAMA Cardiology.
LIMITATIONS:
The doses of furosemide-equivalent loop diuretics were unavailable for some patients. The changes in doses were assessed only at certain timepoints without capturing potential fluctuations between them. The sample size of subgroups receiving both loop and nonloop diuretics was small.
DISCLOSURES:
The FINEARTS-HF trial was funded by Bayer. Several authors reported being employees of, receiving travel support and/or research grants from, serving on advisory boards, and having other financial ties with Bayer. Multiple authors reported having similar financial relationships, including leadership positions with several other pharmaceutical and healthcare companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.