Finerenone may prevent pneumonia and COVID-19 in patients with chronic kidney disease (CKD) and type 2 diabetes, according to a secondary analysis of patient-level data from FIDELITY.
FIDELITY is a prespecified pooled analysis of the randomized, double-blind, placebo-controlled phase 3 FIDELIO-DKD and FIGARO-DKD clinical trials.
Investigators analyzed data gathered from 12,999 patients in the FIDELITY safety population during the COVID-19 pandemic. Of these patients, 6510 and 6489 were randomly assigned to receive finerenone (10 or 20 mg once daily) or matching placebo, respectively. Participants had a urine albumin to creatinine ratio of 30 to 5000 mg/g and an estimated glomerular filtration rate of 25 mL/min/1.73 m2 or higher.
The finerenone group had a significant 29% reduced risk of pneumonia with 4.7% vs 6.7% of patients in the finerenone vs placebo group experiencing pneumonia, Bertram Pitt, MD, of the University of Michigan School of Medicine in Ann Arbor, and colleagues reported in JAMA Network Open. Finerenone-treated patients had a significant 31% reduced risk of serious pneumonia, which occurred in 2.6% vs 3.9% of the finerenone and placebo groups, respectively.
Receipt of finerenone also was significantly associated with a 27% reduced risk of COVID-19 infection with 1.3% vs 1.8% of the finerenone vs placebo group contracting the coronavirus, respectively. Among the study’s limitations, the investigators acknowledged that pneumonia and COVID-19 cases were not formally adjudicated.
Dr Pitt’s team suggested that finerenone, a selective, nonsteroidal mineralocorticoid receptor antagonist, may exert several beneficial effects, including improvement in pulmonary inflammation and fibrosis and upregulation of ACE2 expression.
“Further research into elucidating if mineralocorticoid receptor blockade reduces pneumonia- and COVID-19–related complications in other patient groups would have significant medical implications, especially considering the limited treatment options for COVID-19 complications,” according to the investigators.
Disclosure: This research was supported by Bayer. Please see the original reference for a full list of disclosures.
Pitt B, Agarwal R, Anker SD, et al. Association of finerenone use with reduction in treatment-emergent pneumonia and COVID-19 adverse events among patients with type 2 diabetes and chronic kidney disease. JAMA Netw Open. Published: October 26, 2022. doi:10.1001/jamanetworkopen.2022.36123