Effectiveness and safety of finerenone in membranous nephropathy patients: a retrospective, real‑world study

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Abstract
Purpose We aimed to conduct a retrospective analysis to assess the efficacy and safety of finerenone in patients with membranous nephropathy (MN). Methods This study conducted a retrospective analysis of patients with MN who were treated with finerenone for follow-up period ranging from 3 to 6 months. The study compared the estimated glomerular filtration rate (eGFR), urine total protein-to-creatinine ratio (PCR), urine albumin-to-creatinine ratio (ACR), serum creatinine concentration (SCr), blood pressure and serum potassium (K+) during the follow-up period. Result In this study, 20 patients with MN were treated with finerenone for a follow-up period of 3 to 6 months. Prior to treatment, the average eGFR was 65.15 mL/min/1.73 m2, the average PCR was 3643.63 mg/g, and the average ACR was 2489.44 mg/g. After 3 months of treatment, 80% of patients experienced a decrease in PCR. The median decrease percentages in PCR and ACR are 24.49% and 28.82%, respectively. After 6 months of treatment, the median decrease percentages in PCR and ACR are 42.03% and 43.66%, respectively while the eGFR remained stable with little variation from baseline. During the treatment period, there were minimal changes in serum potassium levels and serum creatinine levels and no treatment discontinuations or hospitalizations due to hyperkalemia were observed. Blood pressure decreased by about 10 mmHg in 6 patients (30%), while there was no difference before and after the addition of finerenone in the remaining 14 (70%) patients. Conclusion The retrospective analysis indicates that finerenone treatment led to significant reductions in PCR and ACR in patients with membranous nephropathy over a 3 to 6-month period, with minimal impact on eGFR, SCr, and K+ levels, highlighting its capacity as a therapeutic option for MN patient group.

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