New drug for diabetic kidney disease has promising results

In an international study, finerenone was effective at reducing protein in the urine without the rate of side effects of other drugs in the class.

Diabetic patients with high or very high albuminuria were randomly assigned to receive finerenone or placebo. Finerenone significantly reduced urinary albumin-creatinine ratio at day 90 versus placebo. In the image, histology of a human kidney

Patients with chronic kidney disease usually have high levels of protein in their urine. This is effectively treated with a renin-angiotensin system blocker combined with a mineralocorticoid receptor antagonist. However, available therapies are underused because of an increased risk of high blood potassium levels (hyperkalemia).

But now a new option looks promising, based on positive results with a nonsteroidal mineralocorticoid receptor antagonist, finerenone (BAY94-8862). In an international study sponsored by Bayer, diabetic patients with high or very high albuminuria (n=823) taking an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker were randomly assigned to also receive finerenone or placebo.

As reported in JAMA (online, 1 September 2015)[1]
, finerenone reduced urinary albumin-creatinine ratio at day 90 versus placebo and hyperkalemia only occurred in 0–3.2% of finerenone-treated patients. A longer-term study will be carried out to investigate clinical endpoints.

References

[1] Bakris GL, Agarwal R, Chan JC et al : Mineralocorticoid receptor antagonist tolerability study–diabetic nephropathy (ARTS-DN) study group. Effect of finerenone on albuminuria in patients with diabetic nephropathy: a randomized clinical trial. JAMA 2015;314(9):884–894. doi: 10.1001/jama.2015.10081.

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Citation
The Pharmaceutical Journal, PJ, 12 September 2015, Vol 295, No 7879;295(7879):DOI:10.1211/PJ.2015.20069299