What is the clinical evidence from this study?

Study design: Cohort. Population: Type 2 diabetes mellitus (T2DM) (n=9120). Intervention: Finerenone vs. Spironolactone or eplerenone. Primary outcome: Major adverse cardiovascular events (MACEs) (HR 0.53 vs spironolactone, HR 0.66 vs eplerenone, 95% CI 0.43-0.66 vs spironolactone, 0.50-0.87 vs eplerenone).

June 11, 2025Open Access

Nonsteroidal mineralocorticoid receptor antagonists and cardiovascular events in type 2 diabetes: a retrospective study

Key Result

Finerenone significantly reduced the risk of MACE compared with spironolactone (HR 0.53; 95% CI 0.43-0.66) and eplerenone (HR 0.66; 95% CI 0.50-0.87) in patients with type 2 diabetes.

Study Design

Type

Cohort (n=9,120)

Multicenter

Yes

Structured PICO

Does finerenone reduce cardiovascular events compared to spironolactone or eplerenone in adult patients with type 2 diabetes?

Population

Adult patients with type 2 diabetes mellitus (T2DM) newly prescribed finerenone, spironolactone, or eplerenone (n=9,120 total matched patients: 2,957 finerenone matched to spironolactone, 1,603 finerenone matched to eplerenone).

Intervention

Finerenone

Comparator

Spironolactone or eplerenone (1:1 propensity score matched)

Outcome

Major adverse cardiovascular events (MACEs), heart failure, and mortality over 24 months of follow-upcomposite

In a real-world setting, finerenone is associated with significantly lower rates of MACE, mortality, and heart failure events compared to spironolactone and eplerenone in patients with type 2 diabetes.

Main Result

Effect estimate: HR 0.53 vs spironolactone, HR 0.66 vs eplerenone (95% CI 0.43-0.66 vs spironolactone, 0.50-0.87 vs eplerenone)

Abstract

AIMS: Nonsteroidal mineralocorticoid receptor antagonists such as finerenone mitigate cardiorenal risks in patients with type 2 diabetes mellitus (T2DM). Real-world evidence comparing finerenone with spironolactone and eplerenone remains limited. This study aimed to evaluate the cardiovascular outcomes in T2DM patients treated with finerenone vs. spironolactone or eplerenone using real-world data. METHODS AND RESULTS: A retrospective cohort analysis was conducted using the TriNetX US Collaborative Network database. Adult patients with T2DM who were newly prescribed finerenone, spironolactone, or eplerenone were included (2021-2024). One-to-one propensity score matching was applied to eligible participants, resulting in 2957 finerenone users matching with spironolactone users and 1603 finerenone users matching with eplerenone users. Cardiovascular outcomes, including major adverse cardiovascular events (MACEs), heart failure, and mortality, were assessed over 24 months of follow-up. Hazard ratios (HRs) with 95% confidence intervals (CI) were calculated using Cox regression models. Finerenone users had significantly lower rates of MACE compared with spironolactone users (HR: 0.53, 95% CI: 0.43-0.66) and eplerenone (HR: 0.66, 95% CI: 0.50-0.87). Mortality was also reduced with finerenone vs. spironolactone (HR: 0.45, 95% CI: 0.35-0.57) and eplerenone (HR: 0.56, 95% CI: 0.41-0.75). Heart failure events were fewer with finerenone than with spironolactone (HR: 0.70, 95% CI: 0.55-0.90) and eplerenone (HR: 0.70, 95% CI: 0.50-0.99). Differences in acute myocardial infarction and stroke rates were not statistically significant. CONCLUSION: Finerenone demonstrated superior cardiovascular outcomes compared with spironolactone and eplerenone in patients with T2DM with significant reductions in MACE, mortality, and heart failure events.