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Finerenone for IgA Nephropathy After Renin-Angiotensin System Inhibitors Discontinuation: A Multicentre Retrospective
Fang Zeng1,2, Xiang Li1, Yang Yang1
1Department of Nephrology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
Background:
Finerenone has emerged as a promising therapeutic agent for IgA nephropathy (IgAN). The role of finerenone in IgAN patients who have discontinued renin-angiotensin system inhibitor (RASi) therapy remains poorly defined.
Methods:
This retrospective, multicentre cohort study enrolled patients with primary IgAN who received finerenone and/or RASi treatment. Participants were categorised into three groups: the finerenone plus RASi, finerenone (after RASi discontinuation) and RASi groups. All participants had a baseline estimated glomerular filtration rate (eGFR) ≥ 25 mL/min/1.73 m2 and urinary total protein (UTP) ≥ 0.5 g/day. The primary outcomes included the percentage change in UTP from baseline and the rate of significant response (defined as ≥ 50% reduction in UTP and < 20% increase in serum creatinine).
Results:
Following 1:1:1 propensity score matching, a total of 258 patients were analysed, with 86 in each group. At 12 months, UTP decreased by 32.24% in the finerenone group and 34.35% in the RASi group (p = 0.220). The finerenone plus RASi group achieved a significantly greater reduction of 54.43% compared with either monotherapy group (both p < 0.01). Kaplan-Meier analysis confirmed that the finerenone plus RASi group achieved superior significant response rates compared with either monotherapy group (both log-rank p = 0.001). No significant difference was observed between the RASi and finerenone groups (log-rank p = 0.856). Although the finerenone plus RASi group exhibited a numerically steeper total eGFR decline (-1.48 vs. -0.44 vs. -0.52 mL/min/1.73 m2/year) and a greater increase in the chronic eGFR slope (0.66 vs. 0.37 vs. 0.49 mL/min/1.73 m2/year), neither difference reached statistical significance compared with the finerenone or RASi groups. The incidence of adverse events was comparable across all three groups.
Conclusion:
Finerenone achieved short-term proteinuria reductions in RASi discontinued IgAN patients similar to those achieved with RASi monotherapy. Finerenone combined with RASi enhanced antiproteinuric efficacy while maintaining safety.
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