Dr Javed Butler Explains How Finerenone Is Shaping New Treatment Standards for HF

Cardiologist and clinical trialist Javed Butler, MD, serves as senior vice president for the health system at Baylor Scott and White Research Institute in Dallas and also as a distinguished professor of medicine at the University of Mississippi in Jackson. At the 2024 European Society of Cardiology Congress, he spoke with The American Journal of Managed Care^® about his late-breaking data, which were a highlight of the meeting for many attendees.

The FINEARTS-HF trial found that finerenone, a mineralocorticoid receptor antagonist (MRA), decreased the risk of heart failure escalation and hospitalizations in patients with heart failure with mildly reduced and preserved ejection fraction (HFREF and HFPEF, respectively).

From your perspective, what were the main takeaways from the findings of the FINEARTS-HF clinical trial?

It's all good. I mean, that was the largest trial presented here in the heart failure space—a big outcomes trial; it was a positive trial. A couple of positive things that came out of it. One is that now that SGLT2 [sodium-glucose cotransporter 2] inhibitors have become the standard of care in patients with heart failure and mildly reduced and heart failure with preserved ejection fraction, one question always was whether there will be an incremental benefit. So in the subgroup analysis of those with and without SGLT2 inhibitor, we saw no heterogeneity. So that is one sort of positive thing. The second thing is that although there were some signals in some patients in the TOPCAT trial that there may be a benefit, the overall trial, nevertheless, was not positive, right? And now, with this trial being positive, at least, to my read, and it's all new, and it'll take some time for us all to digest, but now it seems like that, along with SGLT2 inhibitors, MRAs will be a pillar of therapy, and that dual therapy should be given to all HFPEF patients. So I think, in that sense, it was a very meaningful trial.

Based on these findings, do you think access to finerenone will broaden and improve for patients?

I mean, that's the hope, right? So one is that the cost of the drug is really an issue. It's an issue overall for the health care system. It's also an issue for disparities in health care and insurance coverage and all those kinds of things. On the other hand, disease progression is also very costly. So if people are not on therapies and they get hospitalized and all that kind of stuff, so at the end of the day, not only for good medical reasons that you've got to treat people, but for also, from an economic perspective, treating the patients and treating the patients earlier and stopping those recurrent hospitalizations and whatnot is sort of in the best interest. And then at the end of the day, the cost-effectiveness is a very time-limited metric because these drugs then go generic after a little while. So whatever the cost implications today are won't be the same cost implications tomorrow. So if you put all these things together, I think it's a positive development when we have effective therapies for our patients.