FIDELITY: Cardiorenal benefits of finerenone, regardless of LVH status

Finerenone demonstrated cardiorenal benefits across the complete spectrum of patients with chronic kidney disease (CKD) and type 2 diabetes (T2D), regardless of left ventricular hypertrophy (LVH) status at baseline. The data of the FIDELITY analysis suggest that patients with LVH may benefit more from the use of finerenone than patients without LVH concerning their risk of HF hospitalisation [1].

Finerenone is a novel, selective, non-steroidal mineralocorticoid receptor antagonist (MRA), which has demonstrated cardiovascular and renal benefits in patients with CKD and T2D in the FIDELIO-DKD (NCT02540993) and FIGARO-DKD trials (NCT02545049) [2,3]. The current FIDELITY analysis included 13,171 patients from both of these trials to assess the efficacy of finerenone on cardiovascular and renal outcomes across a broad spectrum of patients with CKD or T2D. The primary analysis of FIDELITY displayed a 14% and 23% reduction in the risk of adverse cardiovascular outcomes and progression of CKD, respectively, in patients treated with finerenone compared with patients treated with placebo. The current analysis assessed the performance of finerenone according to LVH status. Prof. Gerasimos Filippatos (Attikon University Hospital, Greece) presented the findings of this analysis.

In total, 9.6% of the patients had LVH at baseline. Finerenone outperformed placebo in reducing the risk of cardiovascular adverse events, regardless of LVH status (LVH HR 0.72 vs non-LVH HR 0.89; P_interaction=0.108). Further analysis suggested that finerenone reduced the risk of HF hospitalisation particularly prominent in patients with LVH over patients without LVH (HR 0.34 vs HR 0.86; P_interaction=0.002). Furthermore, finerenone was associated with a reduced risk of adverse renal events, compared with placebo, irrespective of LVH status (LVH HR 0.56 vs non-LVH HR 0.80; P_interaction=0.178). Finally, although the risk of hyperkalaemia was increased in patients on finerenone, regardless of LVH status, the number of discontinuations due to this adverse event was low (0.2%).

1. Filippatos G, et al. Finerenone in chronic kidney disease and type 2 diabetes: A FIDELITY analysis of left ventricle hypertrophy. LBT 2, Heart Failure 2022, 21–24 May, Madrid, Spain.
2. Bakris GL, et al. N Engl J Med 2020;383:2219–2229
3. Pitt B, et al. N Engl J Med 2021;385:2252–2263

 

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Posted on 25 May, 2022