Effectiveness and safety of finerenone in IgA nephropathy patients

Abstract Background and Hypothesis IgA 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 ACEI/ARB regimen in IgAN patients. Methods Our study was a single-center, observational, retrospective clinical study. 52 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 UPCR and 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 52 IgAN patients were enrolled, including 19 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 to the ACEI/ARB group (-52.10% [IQR, -65.71%, -6.12%] vs -21.25% [IQR, -39.84%, -6.19%]; P = 0.04). 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 = 0.024). 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 = 0.033). No significant changes in eGFR were observed between the groups (P = 0.091). The response rate was significantly higher in the finerenone combined with ACEI/ARB group compared to the ACEI/ARB group (73.7% vs 39.4%, P = 0.017). 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.