Heart failure outcomes better with nonsteroidal vs steroidal MRAs

In the treatment of patients with heart failure (HF), the use of nonsteroidal mineralocorticoid receptor antagonists (MRAs) such as finerenone appears to improve clinical outcomes compared with steroidal MRAs, as shown in a retrospective study.

For the study, researchers used data from the TriNetX database. They identified adult patients with HF who initiated treatment with either a nonsteroidal or a steroidal MRA.

The composite of all‐cause mortality, all‐cause hospitalization, and worsening HF was assessed at 1 year as the primary outcome. Secondary outcomes included each component individually and safety events.

The analysis included a propensity-score matched cohort of 1,619 nonsteroidal MRA users and 1,619 steroidal MRA users. Baseline characteristics were balanced between the two groups, including age (mean, 69.8 vs 70.1 years), the proportion of female patients (38.3 percent vs 40.3 percent), racial composition (White: 45.3 percent vs 45.6 percent), as well as the prevalence of key comorbidities such as diabetes (68 percent vs 69 percent), chronic kidney disease (63.8 percent vs 63.5 percent), and ischaemic heart disease (46.3 percent vs 45.8 percent).

The primary composite outcome occurred in significantly fewer patients in the nonsteroidal MRA group than in the steroidal MRA group (26.6 vs 34 per 100 person‐years), with nonsteroidal MRA use being associated with a 21-percent risk reduction (hazard ratio [HR], 0.79, 95 percent confidence interval, 0.70–0.90; p<0.001).

Compared with steroidal MRAs, nonsteroidal MRAs were also associated with reduced risks of all‐cause mortality (HR, 0.49), hospitalization (HR, 0.80), and HF worsening (HR, 0.76). Results were consistent across subgroups.

Safety outcomes were similar between the two groups.