Finerenone May Protect Against Pneumonia, COVID-19 in Diabetes and CKD

Finerenone may reduce the risk for pneumonia- and COVID-19-related adverse events via mineralocorticoid receptor blockade.

Results of a study published in JAMA Network Open found evidence suggesting finerenone is protective against pneumonia- and COVID-19-related adverse events among patients with type 2 diabetes and chronic kidney disease (CKD).

Data for this study were sourced from a pooled analysis of 2 multicenter, double-blind, placebo-controlled, event-driven, phase 3 randomized clinical trials. In this study, a subset of patients (N=13,026) with type 2 diabetes and CKD were evaluated for AEs related to pneumonia and COVID-19 infection on the basis of receiving finerenone (n=6510) or placebo (n=6489). Chronic kidney disease was defined as a urine albumin to creatine ratio of 30:5000 mg/g and an estimated glomerular filtration rate of at least 25 mL/min/1.73 m2.

Among patients who did (n=741) and did not (n=12,258) develop pneumonia, the mean (SD) age was 66.0 (9.31) and 64.7 (9.54) years, 72.3% and 69.4% were men, 68.8% and 68.0% were White, 58.2% and 53.9% had obesity, and 17.7% and 16.0% were current smokers, respectively.

During a median follow-up period of 2.6 years, 4.7% of finerenone recipients and 6.7% of placebo recipients developed treatment-emergent pneumonia, indicating a significant association between finerenone treatment and reduced pneumonia risk (hazard ratio [HR], 0.71; 95% CI, 0.64-0.79; P <.001).

Treatment with finerenone also was associated with a significantly decreased risk for severe pneumonia (HR, 0.69; 95% CI, 0.60-0.79; P <.001), COVID-19 infection (HR, 0.73; 95% CI, 0.60-0.89; P =.002), and severe COVID-19 infection (HR, 0.63; 95% CI, 0.47-0.83; P =.001).

[T]he striking reduction in risk of pneumonia observed in both independent studies might suggest that the propagation of pulmonary infection into lobar or bronchial consolidation may be reduced by finerenone.

Receipt of finerenone vs placebo was associated with a reduced rate of pneumonia-related AEs (4.7% vs 6.7%) and severe pneumonia-related AEs (2.6% vs 3.9%), with similar findings for COVID-19-related AEs (1.3% vs 1.8%) and severe COVID-19-related AEs (0.6% vs 0.9%).

Rates of other respiratory infections, including nasopharyngitis, bronchitis, and influenza did not differ significantly between the 2 patients cohorts.

These results may be limited as both antigen and polymerase chain reaction testing for SARS-CoV-2 infection were not widely available at the time of these studies.

According to the researchers, “the striking reduction in risk of pneumonia observed in both independent studies might suggest that the propagation of pulmonary infection into lobar or bronchial consolidation may be reduced by finerenone.”

Disclosure: Multiple authors declared affiliations with industry. Please see the original reference for a full list of disclosures.

References:

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: a FIDELITY pooled secondary analysis. JAMA Netw Open. 2022;5(10):e2236123. doi:10.1001/jamanetworkopen.2022.36123