We are analyzing https://link.springer.com/article/10.1007/s40119-022-00269-3.

Title:
Cardiovascular and Renal Outcomes with Finerenone, a Selective Mineralocorticoid Receptor Antagonist | Cardiology and Therapy
Description:
Overactivation of the renin–angiotensin–aldosterone system (RAAS) has been shown to be pathologic in heart failure and albuminuric chronic kidney disease (CKD), triggering pro-inflammatory and pro-fibrotic cellular pathways. The standard of care in these disease states includes treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers. Mineralocorticoid receptor antagonists (MRAs) are also a mainstay in the treatment of heart failure with reduced ejection fraction; however, therapy is often limited by treatment-related hyperkalemia. In albuminuric CKD, the risk of hyperkalemia, acute kidney injury (AKI), and hypotension also remains significant. Finerenone is a novel non-steroidal MRA that may obviate some of these concerns and have therapeutic potential in additional patient populations. Finerenone was developed using the chemical structure of a dihydropyridine channel blocker but optimized to create a bulky MRA without any activity at the L-type calcium channel. It has several novel cellular mechanisms that may account for its ability to reduce cardiac hypertrophy and proteinuria more efficiently than an equinatriuretic dose of a steroidal MRA, while retaining anti-inflammatory and anti-fibrotic properties. Finerenone also has a lower rate of treatment-related hyperkalemia and AKI than steroidal MRAs with a smaller effect on systolic blood pressure, greatly expanding its therapeutic utility. The recently published FIGARO-DKD and FIDELIO-DKD trials demonstrate that treatment with finerenone in patients with type II diabetes and albuminuric CKD results in improved cardiovascular outcomes and a lower risk of CKD progression. Patients enrolled in these studies were already on maximally tolerated ACE inhibitor or angiotensin receptor blocker therapy. Trials investigating finerenone’s therapeutic effect in patients with heart failure with preserved ejection fraction (HFpEF) and non-diabetic CKD, as well sodium–glucose cotransporter 2 (SGLT2) and finerenone combination therapy in patients with diabetic nephropathy, are ongoing.
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Keywords {🔍}

finerenone, article, pubmed, google, scholar, heart, kidney, cas, failure, patients, disease, aldosterone, participants, cardiovascular, receptor, trial, risk, spironolactone, mineralocorticoid, treatment, ckd, eplerenone, egfr, chronic, reduction, compared, group, hyperkalemia, cardiac, showed, renal, diabetes, trials, type, effect, med, mras, reduced, significant, pressure, mlmin, death, placebo, therapy, steroidal, blood, hfpef, study, ejection, fraction,

Topics {✒️}

redox-sensitive mtor/s6k1 pathway renin-angiotensin-aldosterone system stimulation nf-kb nuclear factor kappa aldosterone/salt-induced hypertensive rats class ii–iv heart failure nyha class ii–iv hfref class iib/level b angiotensin-receptor antagonist irbesartan mario funes hernandez recently published figaro-dkd angiotensin-converting enzyme inhibitor nyha class ii–iv urine albumin–creatinine ratio mineralocorticoid receptor antagonists-pharmacodynamics local renin-angiotensin system angiotensin-converting enzyme inhibition erk/mapk signaling pathway renin–angiotensin–aldosterone system renin-angiotensin-aldosterone system mitogen-activated protein kinase paragon-hf steering committee aldosterone-induced cardiorenal disease l-type calcium channel fidelio-dkd trials demonstrate angiotensin receptor–neprilysin inhibitors article download pdf 17α-thioacetyl group replaced long-term kidney disease nyha class ii hfref deoxycorticosterone/salt-treated rats pro-fibrotic cellular pathways term=finerenone&draw=2&rank=8 term=finerenone&draw=2&rank=7 term=finerenone&draw=2&rank=1 fidelio-dkd trials demonstrated phase 3 fidelio-dkd trial multicenter phase 2b rct breakthrough emperor-preserved trial brain natriuretic peptide key regulatory region emphasis-hf trial showed nt-probnp levels compared gov/ct2/show/nct05047263 gov/ct2/show/nct04435626 gov/ct2/show/nct05254002 mr–aldosterone complex recruits long-term renal outcomes angiotensin-converting enzyme chronic kidney disease ros reactive oxygen species

Questions {❓}

TOPCAT misses its primary endpoint: should spironolactone be abandoned in HFpEF?
Gov/ct2/show/NCT04435626?
Gov/ct2/show/NCT05047263?
Gov/ct2/show/NCT05254002?

Schema {🗺️}

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         headline:Cardiovascular and Renal Outcomes with Finerenone, a Selective Mineralocorticoid Receptor Antagonist
         description:Overactivation of the renin–angiotensin–aldosterone system (RAAS) has been shown to be pathologic in heart failure and albuminuric chronic kidney disease (CKD), triggering pro-inflammatory and pro-fibrotic cellular pathways. The standard of care in these disease states includes treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers. Mineralocorticoid receptor antagonists (MRAs) are also a mainstay in the treatment of heart failure with reduced ejection fraction; however, therapy is often limited by treatment-related hyperkalemia. In albuminuric CKD, the risk of hyperkalemia, acute kidney injury (AKI), and hypotension also remains significant. Finerenone is a novel non-steroidal MRA that may obviate some of these concerns and have therapeutic potential in additional patient populations. Finerenone was developed using the chemical structure of a dihydropyridine channel blocker but optimized to create a bulky MRA without any activity at the L-type calcium channel. It has several novel cellular mechanisms that may account for its ability to reduce cardiac hypertrophy and proteinuria more efficiently than an equinatriuretic dose of a steroidal MRA, while retaining anti-inflammatory and anti-fibrotic properties. Finerenone also has a lower rate of treatment-related hyperkalemia and AKI than steroidal MRAs with a smaller effect on systolic blood pressure, greatly expanding its therapeutic utility. The recently published FIGARO-DKD and FIDELIO-DKD trials demonstrate that treatment with finerenone in patients with type II diabetes and albuminuric CKD results in improved cardiovascular outcomes and a lower risk of CKD progression. Patients enrolled in these studies were already on maximally tolerated ACE inhibitor or angiotensin receptor blocker therapy. Trials investigating finerenone’s therapeutic effect in patients with heart failure with preserved ejection fraction (HFpEF) and non-diabetic CKD, as well sodium–glucose cotransporter 2 (SGLT2) and finerenone combination therapy in patients with diabetic nephropathy, are ongoing.
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      headline:Cardiovascular and Renal Outcomes with Finerenone, a Selective Mineralocorticoid Receptor Antagonist
      description:Overactivation of the renin–angiotensin–aldosterone system (RAAS) has been shown to be pathologic in heart failure and albuminuric chronic kidney disease (CKD), triggering pro-inflammatory and pro-fibrotic cellular pathways. The standard of care in these disease states includes treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers. Mineralocorticoid receptor antagonists (MRAs) are also a mainstay in the treatment of heart failure with reduced ejection fraction; however, therapy is often limited by treatment-related hyperkalemia. In albuminuric CKD, the risk of hyperkalemia, acute kidney injury (AKI), and hypotension also remains significant. Finerenone is a novel non-steroidal MRA that may obviate some of these concerns and have therapeutic potential in additional patient populations. Finerenone was developed using the chemical structure of a dihydropyridine channel blocker but optimized to create a bulky MRA without any activity at the L-type calcium channel. It has several novel cellular mechanisms that may account for its ability to reduce cardiac hypertrophy and proteinuria more efficiently than an equinatriuretic dose of a steroidal MRA, while retaining anti-inflammatory and anti-fibrotic properties. Finerenone also has a lower rate of treatment-related hyperkalemia and AKI than steroidal MRAs with a smaller effect on systolic blood pressure, greatly expanding its therapeutic utility. The recently published FIGARO-DKD and FIDELIO-DKD trials demonstrate that treatment with finerenone in patients with type II diabetes and albuminuric CKD results in improved cardiovascular outcomes and a lower risk of CKD progression. Patients enrolled in these studies were already on maximally tolerated ACE inhibitor or angiotensin receptor blocker therapy. Trials investigating finerenone’s therapeutic effect in patients with heart failure with preserved ejection fraction (HFpEF) and non-diabetic CKD, as well sodium–glucose cotransporter 2 (SGLT2) and finerenone combination therapy in patients with diabetic nephropathy, are ongoing.
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      name:Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, USA
      name:Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, USA

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