Effectiveness and safety of finerenone in IgA nephropathy patients.

BACKGROUND AND HYPOTHESIS: Immunoglobulin A nephropathy (IgAN) is the most common form of glomerulonephritis and a common cause of end-stage kidney disease. This study aimed to evaluate the effectiveness and safety of finerenone in combination with an angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker (ACEI/ARB) regimen in IgAN patients.

METHODS

Our study was a single-center, observational, retrospective clinical study. Fifty-two primary IgAN patients were added. Patients were divided into two groups: the finerenone combined with ACEI/ARB group and the ACEI/ARB group. The primary endpoint was treatment response, defined as the percentage change in urinary protein/creatinine ratio (UPCR) and estimated glomerular filtration rate (eGFR) from baseline to 6 months. The secondary endpoint was the safety of finerenone, with adverse events recorded during treatment. Clinical data were collected from IgAN patients.

RESULTS

Of the 52 IgAN patients enrolled, 19 were in the finerenone combined with ACEI/ARB group and 33 in the ACEI/ARB group. At 6 months, the percentage change in UPCR was significantly greater in the finerenone combined with ACEI/ARB group compared with the ACEI/ARB group [-52.10% (interquartile range, IQR -65.71%, -6.12%) vs -21.25% (IQR -39.84%, -6.19%); P = .04]. Furthermore, the UPCR was lower in the finerenone combined with ACEI/ARB group [0.41 g/g (IQR 0.30, 0.72) vs 0.68 g/g (IQR 0.49, 1.10); P = .024]. Serum albumin levels were higher in the finerenone combined with ACEI/ARB group than in the ACEI/ARB group (44.84 ± 2.35 g/L vs 42.96 ± 3.27 g/L; P = .033). No significant changes in eGFR were observed between the groups (P = .091). The response rate was significantly higher in the finerenone combined with ACEI/ARB group compared with the ACEI/ARB group (73.7% vs 39.4%, P = .017). No serious adverse events were observed in either group.

CONCLUSIONS

In real-world settings, the finerenone combined with ACEI/ARB regimen significantly improved outcomes in IgAN patients, effectively reducing proteinuria levels and increasing serum albumin levels, while maintaining relatively stable eGFR and exhibiting safety.