Dr Dipti Itchhaporia: There Is Potential for Finerenone Combination Treatment

We want to reach patients early in their disease course to prevent progression, and with finerenone being a targeted therapy, data show there may be an additive cardiorenal benefit when it is coadministered with a sodium glucose co-transporter 2 inhibitor, noted Dipti Itchhaporia, MD, FACC, FAHA, FESC, president of the American College of Cardiology and the Eric and Sheila Samson Endowed Chair in Cardiovascular Health, Hoag Memorial Hospital, Newport Beach, California.

Itchhaporia, who is also the director of disease management at Hoag and associate professor at the University of California, Irvine, spoke with The American Journal of Managed Care®today after the FIGARO-DKD results were presented at ESC Congress 2021.

Transcript

Why is it important to study different populations taking the same therapy, as FIGARO/FIDELIO did for finerenone?

The data have to be generalizable to all of our patients. So, I think that's the main reason. And I think that particularly targeting lower-risk patients, hopefully we can decrease long-term progression if the data are positive. And we always want to reach patients early in the continuum so we can prevent the disease progression.

Can these trial findings help build a case to add finerenone to an existing regimen, even if used with an SGLT2 inhibitor?

I think this study had about 8.4% of the patients were on an SGLT2 [sodium glucose co-transporter 2 inhibitors], and we know that mineralcorticoid receptor overactivation results in deleterious effects on the kidneys and the heart—really promoting inflammation and fibrosis, and progression of kidney and cardiovascular disease. So I think that there's been consistent cardiovascular benefit with finerenone therapy, which was observed independent of, as well as in combination with, the use of an SGLT2 inhibitor agonist.

And I think the point estimates suggested a benefit with the combination used, and I think they saw that in the subgroup. So, I think that the data are suggestive that maybe there's an additive cardiorenal and survival benefit if you do coadministration. Obviously, we need more data to look at this—and we'll need to take a look at look at that extra data to see—but I think that hopefully that data will establish whether the combination therapy finerenone and an SGLT2 inhibitor would really result in greater cardiorenal protection, whether the combination is better than each therapy alone.

Do you see cardiologists prescribing finerenone?

Absolutely. I think given the importance of cardiorenal protection, I see that. Also, another interesting thing about finerenone is that it's a targeted therapy with less hyperkalemia [than other options]. We believe in MRA [mineralcorticoid receptor agonist] therapy for heart failure patients, but I think what has prevented us from using it has been some of the hyperkalemia, which we don't see as high a rating with this drug. Now, obviously, I would like to see trials that enroll heart failure patients. I would also like to see the trial compare the current standard of care, which is spironolactone, with this drug; it's always nice to get that extra data. But I think in terms of utilizing MRAs, which we already believe in, in this type of patient, I think yes, we would—and I think for the cardiorenal protection—but I do think we need a little bit more data.