1. [Mineralocorticoid receptor antagonists in heart failure with preserved/mildly reduced ejection fraction: from TOPCAT to FINEARTS-HF].
- Author
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Tinti MD, De Gennaro L, D'Elia E, Benvenuto M, Cittar M, Limonta R, De Maria R, Carigi S, Bianco M, Di Nora C, Manca P, Matassini MV, Rizzello V, Palmieri V, Battistoni I, Tagliamonte G, Masarone D, Halasz G, Iacovoni A, Iacoviello M, Colivicchi F, Grimaldi M, Oliva F, and Gori M
- Subjects
- Humans, Clinical Trials, Phase III as Topic, Randomized Controlled Trials as Topic, Heart Failure drug therapy, Heart Failure physiopathology, Mineralocorticoid Receptor Antagonists pharmacology, Mineralocorticoid Receptor Antagonists therapeutic use, Naphthyridines therapeutic use, Naphthyridines pharmacology, Stroke Volume drug effects, Stroke Volume physiology
- Abstract
Mineralocorticoid receptor antagonists (MRAs) represent one of the cornerstones of treatment for heart failure with reduced ejection fraction. Post-hoc data from the TOPCAT trial, conducted in patients with heart failure mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), suggest the possible clinical benefit of MRAs, particularly for slightly reduced ejection fraction values. The advent of non-steroidal MRAs, including finerenone, seems to represent a turning point in the treatment for HFmrEF/HFpEF. The favorable results of the trials conducted with finerenone in diabetic patients with chronic kidney disease suggested that this MRA might indeed improve outcomes in HFmrEF and HFpEF, considering that these comorbidities are strongly represented in this patient population. The anti-fibrotic and anti-inflammatory effects of finerenone represents the pathophysiological background for benefit in these patients. Moreover, due to its peculiar pharmacokinetic and pharmacodynamic properties, finerenone was found to be effective in reducing the risk of adverse events typically associated with MRAs. The results of the FINEARTS-HF trial, a phase 3 study including patients with HFmrEF and HFpEF randomized to receive finerenone or placebo, were presented at the 2024 ESC congress: finerenone was associated with a lower rate of heart failure-related events and cardiovascular mortality and may thus represent a new therapeutic option in this patient population.
- Published
- 2025
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