Despite standard of care, a key risk factor remains largely unaddressed in patients with CKD and T2D

MR overactivation contributes to several pathophysiological mechanisms including
:

Sodium retention
Extracellular matrix remodeling and hypertrophy
Inflammation and fibrosis

Your patients need protection against MR overactivation

Kerendia is the first and only selective MRA approved to treat CKD and T2D

With no affinity to other hormone receptors, Kerendia selectively blocks

MR overactivation
MR-mediated sodium reabsorption
Expression of pro-inflammatory and pro-fibrotic mediators

Kerendia selectively and potently blocks MR overactivation in the heart and kidneys

Selected characteristics of 2 classes of MRAs

	Nonsteroidal	Steroidal	Steroidal
Characteristic	Kerendia	Spironolactone	Eplerenone
Potency to MR*	High	High	Low
Selectivity to MR*	High	Low	Medium
Metabolites*	No active metabolites	Multiple active metabolites	No active metabolites
Half-life	Short half-life (~2 to 3 hours)	Long half-life (>20 hours)	Moderate half-life (4 to 6 hours)
Distribution (rodent model)*	Balanced between kidney and heart	Kidney > heart (≥6-fold)	Kidney > heart (~3-fold)
Risk of hyperkalaemia	Finerenone was associated with lower rates of hyperkalaemia than spironolactone in the phase 2 trial ARTS	Finerenone was associated with lower rates of hyperkalaemia than spironolactone in the phase 2 trial ARTS	No head-to-head data exist
Effects on blood pressure	Finerenone was associated with less reduction of SBP compared with spironolactone in the phase 2 trial ARTS	Finerenone was associated with less reduction of SBP compared with spironolactone in the phase 2 trial ARTS	No head-to-head data exist

^{In India, Finerenone is indicated to reduce the risk of sustained eGFR decline, end stage kidney disease, cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure in adult patients with chronic kidney disease (CKD) associated with type 2 diabetes (T2D).}

Read about the FIGARO-DKD and FIDELIO-DKD trial designs

Abbreviations

*Based on preclinical animal models. The clinical consequences of these characteristics are unknown.

BP=blood pressure; CKD=chronic kidney disease; CV=cardiovascular; eGFR=estimated glomerular filtration rate; ESKD=end-stage kidney disease; HbA1c=glycated haemoglobin; HF=heart failure; MI=myocardial infarction; MR=mineralocorticoid receptor; MRA=mineralocorticoid receptor antagonist; SBP=systolic blood pressure; T2D=type 2 diabetes.

References

1
Alicic RZ, et al. Adv Chronic Kidney Dis. 2018;25(2):181-191. doi:10.1053/j.ackd.2017.12.002.
2
Alicic RZ, et al. Clin J Am Soc Nephrol. 2017;12(12):2032–2045.
3
Bakris GL, et al; FIDELIO-DKD Investigators. N Engl J Med. 2020;383(23):2219-2229. doi:10.1056/NEJMoa2025845.
4
Bauersachs J, et al. Hypertension. 2015;65(2):257-263.
5
Kolkhof P, et al. Pharmacol Res. 2021;172:1-13. doi:10.1016/j.phrs.2021.105859.
6
Kerendia European Summary of Product Characteristics (SmPC); February 2023.
7
Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. Kidney Int. 2020;98(4S):S1-S115.
8
Toth-Manikowski S, et al. J Diabetes Res. 2015;2015. doi:10.11552015/697010.
9
Black LM, et al. J Histochem Cytochem. 2019;67(9):663-681. doi:10.1369/0022155419852932.
10
Tesch GH, et al. Front Pharmacol. 2017;8:313. doi:10.3389/fphar.2017.00313.
11
European Medicines Agency. Committee for Medicinal Products for Human Use (CHMP) Assessment report. Kerendia. https://www.ema.europa.eu/en/documents/assessment-report/kerendia-epar-public-assessment-report_en.pdf. December 2021. Accessed August 31, 2022.
12
Kintscher U, et al. Br J Pharmacol. 2022;179:3220–3234.
13
Kolkhof P, et al. Handb Exp Pharmacol. 2017;243:271-305. doi:10.1007/164_2016_76.
14
Pitt B, et al. Eur Heart J. 2013;34(31):2453-63. doi:10.1093/eurheartj/eht187.
15
Fagart J, et al. J Biol Chem. 2010;285(39)-29932-29940. doi:10.1074/jbc.M110.131342. Epub 2010 Jul 22.