A comparative post hoc analysis of finerenone and spironolactone in resistant hypertension in moderate-to-advanced chronic kidney disease - Université de Lorraine Access content directly
Journal Articles Clinical Kidney Journal Year : 2023

A comparative post hoc analysis of finerenone and spironolactone in resistant hypertension in moderate-to-advanced chronic kidney disease

1 Roudebush VA Medical Center [Indianapolis, IN, USA]
2 Indiana University System
3 University of Michigan Medical School [Ann Arbor]
4 University of Texas Southwestern Medical Center [Dallas]
5 UTHSC - The University of Tennessee Health Science Center [Memphis]
6 Memphis Veterans Affairs Medical Center
7 University of Calgary
8 NKUA - National and Kapodistrian University of Athens
9 “Attikon” University Hospital
10 Medical University of Warsaw - Poland
11 Hospital Universitario 12 de Octubre [Madrid]
12 Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research imas12
13 UEM - Universidad Europea de Madrid = European University of Madrid
14 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
15 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
16 INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]
17 Cardiovascular & Renal Clinical Trialists - CRCT - French-Clinical Research Infrastructure Network - F-CRIN [Paris]
18 Hôpital Princesse Grace [Monaco]
19 ITU - IT University of Copenhagen
20 Steno Diabetes Center
21 PUCPR - Pontifícia Universidade Católica do Paraná
22 Arbor Research Collaborative for Health
23 DZHK - German Center for Cardiovascular Research
24 Charité - UniversitätsMedizin = Charité - University Hospital [Berlin]
25 BIH - Berlin Institute of Health
26 Bayer Pharma AG [Berlin]
27 MA - BAYER - Medical Affairs
28 Research and Development, Integrated Analysis Statistics, Bayer AG
29 University of Chicago
Daniel Wilson
  • Function : Author

Abstract

ABSTRACT Background Mineralocorticoid receptor antagonists (MRAs) reduce systolic blood pressure (SBP) and increase serum potassium concentration ([K+]). This indirect comparison investigated any differences in SBP-lowering and hyperkalemia risk between finerenone, a nonsteroidal MRA, and the steroidal MRA spironolactone ± a potassium binder. Methods In FIDELITY (a pooled analysis of FIDELIO-DKD and FIGARO-DKD), a subgroup of patients with treatment-resistant hypertension (TRH) and chronic kidney disease meeting eligibility criteria of the AMBER trial were identified (FIDELITY-TRH). The main outcomes were mean change in SBP, incidence of serum [K+] ≥5.5 mmol/L and hyperkalemia-associated treatment discontinuation. Results at ∼17 weeks were compared with 12 weeks from AMBER. Results In 624 FIDELITY-TRH patients and 295 AMBER patients, the least squares mean change in SBP (mmHg) from baseline was −7.1 for finerenone and −1.3 for placebo {between-group difference −5.74 [95% confidence interval (CI) −7.99 to −3.49], P < .0001} versus −11.7 for spironolactone + patiromer and −10.8 for spironolactone + placebo [between-group difference −1.0 (95% CI −4.4–2.4), P = .58]. The incidence of serum [K+] ≥5.5 mmol/L was 12% for finerenone and 3% for placebo versus 35% with spironolactone + patiromer and 64% with spironolactone + placebo. Treatment discontinuation due to hyperkalemia was 0.3% for finerenone and 0% for placebo versus 7% for spironolactone + patiromer and 23% for spironolactone + placebo. Conclusions In patients with TRH and chronic kidney disease compared with spironolactone with or without patiromer, finerenone was associated with a lower SBP reduction and lower risk of hyperkalemia and treatment discontinuation. Trial Registration: AMBER (NCT03071263), FIDELIO-DKD (NCT02540993), FIGARO-DKD (NCT02545049)
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hal-04023880 , version 1 (10-03-2023)

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Attribution - NonCommercial

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Rajiv Agarwal, Bertram Pitt, Biff F Palmer, Csaba P Kovesdy, Ellen Burgess, et al.. A comparative post hoc analysis of finerenone and spironolactone in resistant hypertension in moderate-to-advanced chronic kidney disease. Clinical Kidney Journal, 2023, 16 (2), pp.293-302. ⟨10.1093/ckj/sfac234⟩. ⟨hal-04023880⟩
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