Utilization and clinical characteristics of patients with type 2 diabetes and chronic kidney disease prescribed finerenone in the United States

Abstract

BACKGROUND: Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, improves renal and cardiovascular outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). However, evidence on its use in clinical practice remains limited. Within the FOUNTAIN platform (NCT05526157; EUPAS48148), this study aimed to characterize the profiles and treatment patterns of patients initiating finerenone in the United States following its regulatory approval in 2021.

METHODS: This observational study used Optum's de-identified Clinformatics® Data Mart Database to identify adults with T2D and CKD who initiated finerenone between July 2021 and September 2023. Baseline demographic and clinical characteristics (e.g., estimated glomerular filtration rate, urine albumin-to-creatine ratio [uACR]) were assessed, and treatment utilization patterns were described.

RESULTS: Among 3,591 new finerenone users, mean age was 72.2 years and 47.5% were female. Most (62.4%) had stage 3 CKD, and of those with recorded uACR, 86.5% had moderate/severe albuminuria (≥30 mg/g). Renin-angiotensin-aldosterone system inhibitors (RAASi; 80.0%), sodium-glucose cotransporter 2 inhibitors (SGLT2i; 41.4%), and glucagon-like peptide-1 receptor agonists (GLP-1 RA; 30.2%) usage was common in the 90 days preceding finerenone initiation. Finerenone was typically initiated as an add-on to RAASi (58.5%), SGLT2i (28.0%), or GLP-1 RA (21.1%); monotherapy usage was infrequent (8.5%). Among those with ≥ 12 months' follow-up, 56.0% remained on finerenone at 12 months and 16.7% had titrated from 10 mg to 20 mg.

CONCLUSIONS: Finerenone was primarily prescribed as a pillar of therapy that is used in combination with complementary medications in patients with T2D and CKD, aligning with clinical guidelines and regulatory labeling.