Data Show Finerenone May Delay Onset of Atrial Fibrillation in Patients with Chronic Kidney Disease, Diabetes

Patients with chronic kidney disease and type 2 diabetes (T2D) administered the nodel treatment finerenone were found approximately 30% less likely to develop atrial fibrillation (AFib) than those taking a placebo, according to data presented at the American College of Cardiology’s 70th Annual Scientific Session.

Results from the FIDELIO-DKD trial released in 2020 showed that the nonsteroidal, selective mineralocorticoid receptor antagonist met its primary endpoint of a significant benefit in a composite of sustained decrease in kidney function, kidney failure, and renal death. The new data show that patients were able to benefit from finerenone treatment regardless of AFib history, which indicates that finerenone can reduce the rate of new-onset AFib, according to the study.

“Finerenone can lower the risk of development of atrial fibrillation in patients with chronic kidney disease and diabetes and can be used as a therapeutic strategy to delay its onset,” said study lead author Gerasimos Filippatos, MD, from the National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital in Athens, Greece, in the press release. “It can also protect the heart and the kidney from further damage caused by chronic kidney disease and diabetes in these patients with or without pre-existing atrial fibrillation.”

The FIDELIO-DKD trial randomized 5674 patients with chronic kidney disease and TD2 to take finerenone or a placebo, with outcomes recorded for a median of 2.6 years. The primary endpoint was a composite of kidney failure, renal death, or sustained decrease in estimated glomerular filtration rate of 40% or more from baseline. The key secondary outcomes were death by loss of heart function, nonfatal heart attack, nonfatal stroke, or hospitalization for heart failure.

Finerenone was found to significantly reduce the risk of kidney events by 18% and the risk of cardiovascular events by 14% compared with placebo. In the new study, the authors evaluated outcomes among patients with and without a history of AFib or atrial flutter as well as the risk of developing AFib or atrial flutter during the study.

The primary and secondary endpoints were found to be significantly lower among patients administered finerenone regardless of AFib status at the start of the study.

“The previously-reported kidney and heart protection with finerenone applied equally to patients with and without pre-existing atrial fibrillation,” Filippatos said in the press release.

Additionally, new-onset AFib or atrial flutter was reported in 3.2% of patients administered finerenone compared with 4.5% in the placebo cohort, which was deemed significant by the study authors.

The researchers said that findings from prior preclinical studies indicate that finerenone may aid in decreasing scarring and thickening of the heart tissue. They hypothesized that this may be due to its ability to block mineralocorticoid receptors, which is a type of protein molecule found on many cell types in the heart and kidney and has been found to be abundant in patients with AFib, according to the study authors.

“Preventing or delaying the onset of atrial fibrillation in patients with chronic kidney disease and diabetes is particularly important since having atrial fibrillation can worsen chronic kidney disease and having diabetes can worsen atrial fibrillation symptoms,” Filippatos said in the press release. “Treatment in these patients can also be challenging because they are prone to developing blood clots [which can lead to stroke] and bleeding. Finerenone has the potential to reduce the burden of atrial fibrillation in these patients.”

Filippatos said that larger studies focused specifically on new-onset AFib are necessary to confirm the findings. Because study participants underwent heart rhythm tests only once per year in FIDELIO-DKD, the researchers said in the release that it is possible they missed asymptomatic AFib or cases among individuals with less severe chronic kidney disease and diabetes.

REFERENCE

Finerenone May Delay Onset of Atrial Fibrillation in Patients with Chronic Kidney Disease, Diabetes. American College of Cardiology. Published May 17, 2021. Accessed May 18, 2021. https://www.acc.org/about-acc/press-releases/2021/05/17/04/32/finerenone-may-delay-onset-of-atrial-fibrillation-in-patients-with-chronic-kidney-disease-diabetes