非奈利酮治疗心衰能治愈吗？

Although tablets have a significant therapeutic effect on heart failure, it needs to be emphasized that it cannot completely cure heart failure.

Spironolactone can be used as an effective auxiliary treatment drug to help patients with heart failure improve their prognosis and delay disease progression. It is usually used to treat chronic heart failure (HF), especially in patients with heart failure with impaired systolic function. It has the effects of protecting the heart, reducing edema, and reducing the risk of heart failure.

About Finerenone

Finerenone is a new type of non-steroidal selective mineralocorticoid receptor antagonist developed by Bayer Company of the United States. Compared with other MRAs, such as spironone and etoridone, it has a lower risk of hyperkalemia and is currently an effective method for the treatment of diabetic nephropathy. But in addition, fenelidone has been shown to significantly reduce the risk of cardiovascular events, including heart failure hospitalization and cardiovascular death.

The effect of fenelidone in the treatment of heart failure

Studies have shown that fenelidone can not only reduce diastolic dysfunction in HFpEF model rats, but also improve cardiac perfusion in rats. Compared with eplerenone, fenelinone was more effective in improving left ventricular function in rats with coronary artery ligation-induced HF model. The Mineralocorticoid Receptor Antagonist Tolerance Study (ARTS) showed that fenelidone can effectively reduce B-type natriuretic peptide, plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), and proteinuria in patients with HF, similar to spironolactone.

Research on Fennelidone in the Treatment of Heart Failure

The results of the Mineralocorticoid Receptor Antagonist Tolerance Study-Heart Failure Trial (ARTS-HF) showed that Fenelidone can effectively reduce NT-proBNP in patients with HF. Similar to eplerenone, ARTS-HF conducted in the Japanese population also obtained the same results.

PEI and other studies have shown that in patients with chronic HF, the anti-ventricular remodeling effect of 10 mg/d of fenelidone (targeted to reduce NT-proBNP by 30%) is equivalent to that of 20 to 50 mg/d of steroid MRA (spironolactone or eplerenone), and as the dose increases, the effect of fenelidone on reducing NT-proBNP levels and urinary albumin/creatinine ratio becomes better.

In summary, fenelidone has a good effect in treating HF, and can achieve the same efficacy as steroidal MRA with a smaller dose.

Prognosis of heart failure treated with fenelinone

ARTS-HF results showed that the all-cause mortality rate in the fenelidone group was similar to that in the eplerenone group, and the cardiovascular mortality rate was lower than that in the eplerenone group. Studies such as PEI have shown that as the dose of fenelidone increases, the risk of cardiovascular death and the incidence of composite endpoints (death from any cause, hospitalization for cardiovascular disease, or worsening of chronic HF) in patients with chronic HF decrease. The above results show that fenelidone can effectively reduce the incidence of cardiovascular events and mortality in patients with HF and improve patient prognosis.

Summary

As the first third-generation highly selective non-steroidal MRA, fenelinone has high selectivity and affinity for MR, and has a shorter t1/2. Compared with steroidal MRA, it is more effective and safer in treating HF and can effectively improve patient prognosis. However, fenelinone cannot currently cure HF.

References

[1] Jie Xiaoming, Song Qian, Yu Tong, et al. Research progress of fenelidone in the treatment of heart failure [J]. Journal of Practical Cardiocerebral and Pulmonary Vascular Diseases, 2024, 32(01):18-21.

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