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.