PS-C21-5: EFFICACY OF SWITCHING FROM EPLERENONE TO ESAXERENONE FOR THE TREATMENT OF PRIMARY ALDOSTERONISM

Background: Mineralocorticoid receptor (MR) antagonist is the first choice for medical therapy for primary aldosteronism (PA) due to bilateral adrenal disease. However, there are many cases of PA in which blood pressure control are inadequate and/or suppression of renin are insufficiently released even under the maximum dose of eplerenone (EPL) approved in Japan. In this study, we investigated the effect of switching to the novel MR antagonist Esaxerenone (ESX) in PA patients whose renin suppression was not released even under the maximum dose of EPL. Methods: Twenty-seven patients (age; 53 ± 10 years, male/female; 14/13) who were diagnosed with PA at our hospital and showed plasma renin activity (PRA) < 1.0 ng/mL/hr even under EPL 100 mg/day were switched to ESX. We investigated changes in blood pressure, PRA, plasma aldosterone concentration (PAC), blood biochemical findings, and concomitant antihypertensive agents in these patients for 12 months. Results: Systolic and diastolic blood pressure decreased significantly from 1 month (133 ± 12/84 ± 8 mmHg) to 12 months (127 ± 10/80 ± 9 mmHg) compared to before switching to ESX (140 ± 16/88 ± 11 mmHg), whereas the rate of concomitant use of other antihypertensive agents did not change (44.4% ¡ú 45.0%). PRA (0.5 ± 0.4 ng/mL/hr) increased significantly from 6 months (0.6 ± 0.4 ng/mL/hr) to 12 months (0.8 ± 0.6 ng/mL/hr). PAC (191 ± 83 ¡ú 188 ± 110 pg/mL), serum potassium (4.3 ± 0.3 ¡ú 4.4 ± 0.4 mEq/L), AST (20 ± 6 ¡ú 22 ± 4 U/L), ALT (21 ± 11 ¡ú 21 ± 5 U/L) and γGTP (34 ± 41 ¡ú 38 ± 34 U/L) did not change. Estimated GFR (78 ± 14 ¡ú 70 ± 15 mL/min/1.73m 2 ) gradually decreased. Conclusions: These results suggest that ESX is a more potent antagonist of MR with equivalent safety to EPL in the management of PA.