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September 18, 2026Cardiovascular TherapeuticsOpen Access

MRA utilization rises in England with spironolactone reaching ~4 million dispensed items by 2025.

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Population

NHS primary care prescriptions dispensed in the community in England

Design

Cohort

Follow-up

2022 to 2025

Key result

Between 2022 and 2025 in England, spironolactone utilisation increased to 4,060,648 items, eplerenone to 1,963,447 items, and finerenone reached 35,484 items, with varying cost trends.

Authors

CKChia Siang KowSHSyed Shahzad HasanKTKaeshaelya Thiruchelvam

Discussion

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Overview

Observed MRA utilization trends support cost monitoring in England; leaves open real-world outcome effects.

Key Points

  • To evaluate temporal trends in primary care utilisation, total expenditure, and cost per item of mineralocorticoid receptor antagonists in England from 2022 to 2025.
  • Retrospective observational analysis using OpenPrescribing primary care dispensing datasets covering English NHS community prescriptions from 2022 to 2025.
  • Evaluated spironolactone, eplerenone, and finerenone across total items dispensed, population-standardised rates per 100,000, actual expenditure in GBP (£), and cost per dispensed item.
  • Spironolactone remained the dominant agent, increasing from 3,140,245 items (5,491 per 100,000) in 2022 to 4,060,648 (6,902 per 100,000) in 2025 alongside rising overall expenditure.
  • Eplerenone dispensing expanded from 1,180,762 items (2,065 per 100,000) to 1,963,447 (3,337 per 100,000), while its unit cost fell to £2.22 in 2025, dropping below spironolactone (£3.13).
  • Finerenone prescriptions grew rapidly from minimal baseline levels to 35,484 items (60.3 per 100,000) in 2025, maintaining the highest cost per item and rising total expenditures.

Study Design

Type

Observational

Structured PICO

P
Population
Population-level prescribing analysis of NHS primary care in England from 2022 to 2025 evaluating mineralocorticoid receptor antagonists.
E
Exposure
Mineralocorticoid receptor antagonists (spironolactone, eplerenone, finerenone)
O
Outcome
Total items dispensed, items per 100,000 population, total Actual Cost (£) and cost per item

Between 2022 and 2025 in England, spironolactone remained the most prescribed MRA, while eplerenone use increased with declining costs and finerenone saw rapid initial uptake.

Limitations

  • Does not establish indication-specific use, comparative effectiveness, safety, adherence or cost-effectiveness
  • Descriptive findings that should be considered hypothesis-generating
  • Does not establish indication-specific use
  • Does not establish comparative effectiveness
  • Does not establish safety
  • Does not establish adherence
  • Does not establish cost-effectiveness

Cite This Study

Kow et al. (2026) conducted an observational in Cardiovascular and renal diseases. Mineralocorticoid receptor antagonists (spironolactone, eplerenone, finerenone) was evaluated on Temporal trends in utilisation, total cost, and cost per item. Between 2022 and 2025 in England, spironolactone utilisation increased to 4,060,648 items, eplerenone to 1,963,447 items, and finerenone reached 35,484 items, with varying cost trends.

synapsesocial.com/papers/6aacf5ed0c46fbdff987dd06https://doi.org/10.1155/cdr/5473277
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Also Consider

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