Oral finerenone may reduce risk of new-onset diabetes in heart failure patients: Lancet

A recent study from the FINEARTS-HF trial revealed that finerenone, which is an oral mineralocorticoid receptor antagonist, significantly reduces the risk of developing new-onset diabetes in patients with heart failure and mildly reduced or preserved ejection fraction. The results were published in the The Lancet Diabetes & Endocrinology journal underline an additional clinical benefit of finerenone in this patient population.

The trial included a total of 6001 participants with New York Heart Association functional class II–IV heart failure, a left ventricular ejection fraction of 40% or higher, and elevated N-terminal pro-B-type natriuretic peptide levels. Of these, 3222 participants (53.7%) without baseline diabetes were analyzed to assess the effect of finerenone on incident diabetes. The patients were randomized in a double-blind manner to receive either finerenone or a placebo and followed for a median duration of 31.3 months.

Incident diabetes was defined as having an HbA1c level of 6.5% or higher on two consecutive visits or the initiation of glucose-lowering therapy. During the follow-up period, 7.2% of participants in the finerenone group and 9.1% in the placebo group developed new-onset diabetes. This translated to event rates of 3.0 per 100 person-years in the finerenone group versus 3.9 per 100 person-years in the placebo group.

The statistical analysis revealed a 24% reduction in the risk of new-onset diabetes with finerenone when compared to placebo (hazard ratio 0.76, 95% CI 0.59–0.97; p=0.026). When accounting for the competing risk of death using Fine–Gray analysis, the findings remained consistent (subdistribution hazard ratio 0.75, 95% CI 0.59–0.96; p=0.024).

These results were robust across sensitivity analyses, including definitions of new-onset diabetes that accounted for HbA1c-only measurements, glucose-lowering drug initiation (excluding SGLT2 inhibitors), and the inclusion of participants treated with glucose-lowering drugs at baseline. The findings highlight that the benefits of finerenone extend beyond its established role in improving cardiovascular outcomes. Also, the effect was consistent across key subgroups, further emphasizing the reliability of these results.

Safety profiles also supported the use of finerenone, with only seven participants reporting adverse events related to new-onset diabetes that were not captured in the predefined criteria. Overall, this study adds to the growing body of data supporting the role of finerenone in heart failure management. These findings suggesting that it offers cardiovascular protection and a significant reduction in diabetes risk for patients with mildly reduced or preserved ejection fraction heart failure.

Source:

Butt, J. H., Jhund, P. S., Henderson, A. D., Claggett, B. L., Desai, A. S., Viswanathan, P., Kolkhof, P., Schloemer, P., Amarante, F., Lam, C. S. P., Senni, M., Shah, S. J., Voors, A. A., Zannad, F., Pitt, B., Vaduganathan, M., Solomon, S. D., & McMurray, J. J. V. (2025). Finerenone and new-onset diabetes in heart failure: a prespecified analysis of the FINEARTS-HF trial. The Lancet. Diabetes & Endocrinology. https://doi.org/10.1016/s2213-8587(24)00309-7