SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1575307
This article is part of the Research TopicNew Frontiers in Heart Failure Therapy: Mechanisms, Efficacy, and ChallengesView all 10 articles
A systematic review and meta-analysis on the efficacy and safety of finerenone in the progression of heart failure
Provisionally accepted
- China-Japan Union Hospital, Jilin University, Changchun, Jilin Province, China
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Abstract Aims Finerenone, a kind of mineralocorticoid receptor antagonist (MRA), may benefit heart failure (HF) patients as MRAs are established effective therapies for HF. Many studies have confirmed the drug's effectiveness in treating kidney disease. However, the efficacy and safety of finerenone on HF are still unclear. So this systematic review and meta-analysis was conducted to assess the preliminary efficacy and safety of finerenone in HF treatment. Methods This systematic review and meta-analysis included randomized controlled trials (RCTs) involving adults with heart failure, diabetes, or chronic kidney disease (CKD) treated with finerenone. The major outcomes were the risk of HF occurrence or worsening, hospitalization due to HF, and secondary outcomes included cardiovascular death and all-cause mortality. Data were extracted and analyzed following PRISMA guidelines, with risk of bias evaluated by the Cochrane Handbook. This review was registered with PROSPERO (CRD42024612580). Results 6 RCTs (n = 21, 295) were included. Finerenone was associated with less risk related to HF occurrence or worsening and hospitalization on account of HF in comparison with placebo (risk rate [RR] 0.81; 95% confidence interval [CI] 0.76 - 0.87; P < 0.00001). However, no prominent differences were found in cardiovascular death (RR 0.93; 95% CI 0.83 - 1.03; P = 0.18) or all-cause mortality (RR 0.94; 95% CI 0.87 - 1.02; P = 0.11). Safety analysis indicated a reduced risk of serious adverse reactions (RR 0.93; 95% CI 0.90 - 0.98; P = 0.005) and discontinuation of study medication on account of adverse events (RR 1.14; 95% CI 1.01 - 1.30; P = 0.04). Conclusion Finerenone appears to decrease the risk related to HF occurrence and progression, particularly in patients with CKD and diabetes, but its impact on overall mortality remains uncertain. The potential benefits need to be balanced against the risk of adverse effects. Further research is essential to explore optimal dosing and treatment duration.
Keywords: finerenone, Heart Failure, efficacy, Safety, Meta-analysis
Received: 13 Feb 2025; Accepted: 21 Aug 2025.
Copyright: © 2025 Peng, Li, Yu, Du and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Beibei Du, China-Japan Union Hospital, Jilin University, Changchun, 130033, Jilin Province, China
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