Finerenone May Protect Patients With Chronic Kidney Disease From Pneumonia-Related Severe Adverse Events

The drug is a selective, nonsteroidal mineralocorticoid receptor antagonist found to also protect against COVID-19 and pneumonia-related adverse events in patients with diabetes.

Finerenone may reduce the adverse events (AEs) associated with pneumonia and COVID-19 in patients with chronic kidney disease (CKD) and type 2 diabetes, according to the authors of a recent study published in JAMA Network Open. The results suggest that finerenone can modulate anti-inflammatory mechanisms that defend against severe AEs.

“We propose that a combination of factors, including improvements in pulmonary inflammation and fibrosis, coupled with upregulation of ACE2 expression and amelioration of right-heart pressure and pulmonary congestion, are likely to lead to an improved pulmonary environment that is less susceptible to a propagation of pulmonary infection and inflammation,” wrote the study authors.

Patients with CKD have a 2-fold greater risk of pneumonia compared to those without CKD. Patients often experience pneumonia as a morbidity that is independent of other morbidities, such as diabetes, cardiovascular disease, asthma, and chronic obstructive pulmonary disease. Patients with CKD who also contract pneumonia have been shown to have a greater risk of hospitalization, mortality, and cardiovascular AEs.

Finerenone is a selective and nonsteroidal mineralocorticoid receptor antagonist (MRA), a class of drug which lessens pulmonary inflammation and may also protect against COVID-19, according to some clinicians. To investigate this further, investigators evaluated the potential for finerenone to protect against AEs associated with pneumonia and COVID-19 in patients with CKD and type 2 diabetes.

Investigators gathered data for this secondary analysis from the FIDELITY study, comprised of the FIDELIO-DKD and FIGARO-DKD studies. They evaluated incidence rate of AEs from pneumonia or COVID-19 in 12,999 patients who either received finerenone or placebo.

After analysis of the data, the investigators found that the occurrence of pneumonia-associated AEs were significantly lower in patients who took finerenone.

“There was also a lower risk of COVID-19 AEs among patients who received finerenone,” study authors wrote. “Fineronone was consistently associated with reduced risk of pneumonia and serious pneumonia vs placebo.”

However, there are limitations in this study. First, patients could have been misdiagnosed as having pneumonia when it could have been heart failure or pulmonary edema. Additionally, antigen and polymerase chain reaction testing for COVID-19 was not widely available at the time of the study.

MRAs function by blocking the mineralocorticoid receptor; in turn, this may create an anti-inflammatory response and reduce the risk of pneumonia and COVID-19-associated AEs.

MRAs can also block the accumulation of active macrophages, which can result from COVID-19 and can lead to pulmonary tissue damage. Further, this accumulation may increase expression of angiotensin-converting enzyme 2, which is the functional host receptor for the SARS-CoV-2 spike protein. As a result, MRAs may protect against lung damage.

“Mineralocorticoid receptor blockade with finerenone was associated with protection against pneumonia and COVID-19 adverse events (AEs) in patients with type 2 diabetes and CKD,” study authors wrote. “However, further clinical studies may be warranted.”

Reference

Pitt, Bertram, Agarwal, Rajiv, Anker, Stefan, et al. Association of Finerenone Use With Reduction in Treatment-Emergent Pneumonia and COVID-19 Adverse Events Among Patients With Type 2 Diabetes and Chronic Kidney Disease. JAMA Netw Open. 2022;5(10):e2236123. doi:10.1001/jamanetworkopen.2022.36123