“Finerenone it is the first selective non-steroidal antagonist of mineralocorticoid receptors, i.e. hormones such as aldosterone
which, by binding to the receptors, determine an increased reabsorption of water and sodium and also stimulate inflammation and fibrosis processes which, if overstimulated, can have consequences in terms of cardiac damage and renal damage. Unlike other mineralocorticoid receptor antagonists that were available before finerenone, the latter is ‘non-steroidal’ and has a completely different structure. This causes it to determine, following the binding with the receptor of these hormones, inhibitory stimuli at the level of cytokines and pro-inflammatory and profibrotic substances”. These are the words of Paola Fioretto, professor of Internal Medicine at the University of Padua, on the sidelines of the meeting promoted by Bayer ‘Towards a future without dialysis: reduction of biomarkers of inflammation and fibrosis with finerenone’ today in Milan. During the event it was the Italian drug agency Aifa has given the green light to the reimbursement of finerenonea new drug for the treatment of chronic kidney disease, stages 3 and 4, associated with type 2 diabetes in adult patients with albuminuria, as an adjunct to standard of care.
“In the experimental model in mice it has been seen that, if they are treated with this drug, inflammation and fibrosis are reduced – adds Fioretto – There is now also data, obtained from the trials that have been conducted on finerenone patients, which demonstrate how in the blood of these patients there is a reduction in various biomarkers of inflammation and fibrosis. This is the big difference.” Furthermore, the main side effect of this category of drugs, which is hyperkalemia, is much less serious and much less frequent with finerenone than with previous steroid receptor antagonists: “So, on the one hand we have a very good safety profile – underlines the ‘expert – and on the other hand we have efficacy from a cardioprotective and nephroprotective point of view demonstrated in clinical trials in patients with type 2 diabetes and chronic kidney disease. This evidence has led the guidelines to recommend finerenone as a first-line drug , together with others, in the holistic management of patients with type 2 diabetes and chronic kidney disease”.
The current therapies that represent the standard of care – it emerged from the meeting – act mainly on metabolic and hemodynamic mechanisms, while the inflammatory and fibrotic processes, which play a crucial role in the progression of chronic kidney disease, before the arrival of finerenone did not were affected by any therapeutic strategy. The addition of this drug therefore guarantees more complete nephroprotection. “One of the aspects that we want to encourage and encourage in the management of these patients in recent years is multidisciplinarity, which generally starts with the general practitioner, followed by endocrinologists, nephrologists and cardiologists, depending on the problems presented by the patient – concludes Fioretto – Holistic management does not only include the pharmacological approach, which today we can guarantee, being able to target the mechanisms that lead to these complications of diabetes from various sides, but also the shared management of this patient’s problems. One thing not very easy to achieve, but we are getting closer and closer to this goal.”
#Fioretto #UniPd #Finerenone #difference #patients #chronic #kidney #disease