Efficacy and Safety of Finerenone in Patients With Primary Aldosteronism: A Multicenter Prospective Study

BACKGROUND: Finerenone is a novel nonsteroidal mineralocorticoid receptor antagonist. However, robust evidence about its efficacy and safety in primary aldosteronism is scarce. METHODS: In this prospective, multicenter, single-arm, and exploratory trial, we enrolled adults (aged ≤75 years) with primary aldosteronism, an office blood pressure (BP) ranging from 140 to 180/90 to 120 mm Hg, and an estimated glomerular filtration rate ≥60 mL/min per 1.73 m². Eligible patients received finerenone (20–40 mg/d) treatment for 12 weeks. The primary outcome was the change in daytime systolic BP at 12 weeks. RESULTS: Fifty-seven patients were ultimately treated. Per-protocol analysis revealed that finerenone treatment significantly reduced mean daytime systolic BP (−6.69±1.60 mm Hg; P <0.001) and diastolic BP (−4.55±1.06 mm Hg; P <0.001) according to ambulatory monitoring. Mean office BP decreased even more substantially (systolic BP, −15.58±1.69 mm Hg; diastolic BP, −8.61±1.02 mm Hg; both P <0.001). The mean increase in serum potassium concentration was 0.39±0.05 mmol/L, and 94.5% of patients exhibited a normal concentration after 12 weeks of treatment (versus baseline 61.8%; P <0.001). Plasma renin activity increased, and 32.7% of patients exhibited a plasma renin activity concentration ≥1 ng/mL per h. According to the Primary Aldosteronism Medical Treatment Outcome criteria, 29.1% and 20.0% of patients achieved complete biochemical and clinical responses, respectively. Treatment was well tolerated. CONCLUSIONS: This study demonstrated the efficacy and safety of finerenone in the treatment of primary aldosteronism, supporting its use as a potential alternative therapy for the condition. Nevertheless, further prospective and head-to-head randomized controlled trials are essential to establish finerenone as a viable substitute for spironolactone. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT06381323.