Evidence for the use of a nonsteroidal mineralocorticoid receptor antagonist for the treatment of chronic kidney disease

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia Pub Date : 2025-03-01 DOI:10.1016/j.nefro.2024.10.004

Mariana Morais David Pliças , Bernardo Marques da Silva , Edgar Avito Fernandes de Almeida

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Abstract

Introduction and objectives

Chronic kidney disease morbimortality drives the development of new drugs. This work summarizes the evidence on the use of non-steroidal mineralocorticoid receptor antagonists on chronic kidney disease.

Materials and methods

A search was performed on PubMed and ClinicalTrials.gov using relevant keywords for clinical trials and observational studies, finished or ongoing, from 2019 to 2023.

Results

Finerenone is currently approved for diabetic kidney disease with albuminuria, with results from two phase three trials, presenting satisfactory results on renal and cardiovascular outcomes and an appropriate safety profile, namely regarding potassium balance. Regarding nondiabetic kidney disease, combining sodium glucose transport protein-2 inhibitors and finerenone points toward reliable results, although these came from non-placebo-controlled trials. An ongoing phase three trial is assessing finerenone efficacy and safety on nondiabetic chronic kidney disease. Esaxerenone is approved for diabetic nephropathies and hypertension in Japan, based on two phase three clinical trials. These trials’ external validity is compromised, as they were only developed in Japan. Ocedurenone presents results from a phase two trial on managing refractory hypertension on chronic kidney disease. Apararenone is being investigated for diabetic kidney disease, with results from a phase two study, limited for only including Japanese patients.

Conclusions

With this review we provide a global perspective on the available clinical results for these drugs to improve its evidence-based use.

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使用非甾体矿皮质激素受体拮抗剂治疗慢性肾病的证据

慢性肾脏疾病的发病率和死亡率推动着新药的开发。本工作总结了非甾体矿皮质激素受体拮抗剂治疗慢性肾脏疾病的证据。材料和方法在PubMed和ClinicalTrials.gov上检索2019年至2023年已完成或正在进行的临床试验和观察性研究的相关关键词。finerenone目前被批准用于糖尿病肾病伴蛋白尿，两项三期试验的结果显示，在肾脏和心血管结局方面取得了令人满意的结果，并具有适当的安全性，即钾平衡。对于非糖尿病肾病，联合使用葡萄糖转运蛋白-2抑制剂钠和芬烯酮可获得可靠的结果，尽管这些结果来自非安慰剂对照试验。一项正在进行的三期试验正在评估芬尼酮对非糖尿病性慢性肾脏疾病的疗效和安全性。基于两项三期临床试验，Esaxerenone在日本被批准用于糖尿病肾病和高血压。这些试验的外部有效性受到了损害，因为它们只是在日本开发的。奥克都列酮在治疗难治性高血压合并慢性肾脏疾病的ii期临床试验结果。Apararenone正在研究用于糖尿病肾病的治疗，其结果来自一项ii期研究，仅限于日本患者。结论通过这篇综述，我们对这些药物的现有临床结果提供了一个全球视角，以改善其循证应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Nefrologia 医学-泌尿学与肾脏学

CiteScore

3.40

自引率

7.70%

发文量

148

审稿时长

47 days

期刊介绍： Nefrología is the official publication of the Spanish Society of Nephrology. The Journal publishes articles on basic or clinical research relating to nephrology, arterial hypertension, dialysis and kidney transplants. It is governed by the peer review system and all original papers are subject to internal assessment and external reviews. The journal accepts submissions of articles in English and in Spanish languages.