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Future Directions and Innovations in Mineralocorticoid Receptor Antagonist Therapy
Shashank Joshi1, Mangesh Tiwaskar2, Jayanta Sharma3
1Consultant Endocrinologist, Department of Diabetology and Endocrinology, Lilavati Hospital and Research Center, Mumbai, Maharashtra, India, Corresponding Author.
The Journal of the Association of Physicians of India
|March 12, 2026
Summary
Mineralocorticoid receptor antagonists (MRAs) are key for treating heart failure and kidney diseases. Combination therapies with SGLT2i and GLP-1RAs show improved results for cardiovascular-kidney-metabolic syndrome.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Mineralocorticoid receptor antagonists (MRAs) are established treatments for heart failure (HF), chronic kidney disease (CKD), and diabetic kidney disease (DKD).
- MRAs act on complementary pathways with sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in cardiovascular-kidney-metabolic (CKM) syndrome.
- Aldosterone and mineralocorticoid receptor (MR) antagonism by MRAs are crucial in managing various conditions.
Purpose of the Study:
- To highlight the role of MRAs in CKM syndrome treatment.
- To explore the benefits of combination therapies involving MRAs, SGLT2i, and GLP-1RAs.
- To discuss the potential of MRA-specific biomarkers for personalized medicine.
Main Methods:
- Review of existing literature on MRA, SGLT2i, and GLP-1RA therapies.
- Analysis of complementary pathways and combination treatment outcomes in CKM syndrome.
- Examination of biomarker utility (UACR, eGFR) for MRA treatment individualization.
Main Results:
- Combination therapies of MRAs with SGLT2i and GLP-1RAs demonstrate superior outcomes in CKM syndrome compared to monotherapies.
- MRAs show promise in ongoing clinical trials due to their unique mechanism of action.
- Disease-specific biomarkers like UACR and eGFR are increasingly used for personalized MRA treatment.
Conclusions:
- Combination therapies involving MRAs, SGLT2i, and GLP-1RAs represent a promising strategy for CKM syndrome.
- Further research into MRA-specific biomarkers could advance precision medicine in cardiovascular and kidney disease management.
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