Finerenone Prescriptions in the US (2021-2024) by Physician Specialty: Analysis of Use and Potential in the CKM Space

IntroductionFinerenone, a non-steroidal mineralocorticoid receptor antagonist (MRA), has demonstrated greater receptor selectivity and fewer side effects compared to older mineralocorticoid receptor antagonists. Clinical trials support its efficacy in reducing kidney disease progression, cardiovascular events, and heart failure outcomes across various patient populations, however, anecdotally, the drug appears infrequently utilized in clinical practice. MethodsA serial, cross-sectional analysis of IQVIAs National Prescription Audit (NPA), which covers over 70% of U.S. outpatient prescription activity, was conducted from July 2021 to December 2024 to examine finerenone prescribing trends focusing on cardiologists and nephrologists. For added context, prescription rates of finerenone were compared to those of two other medications with related mechanisms or indications commonly used in Cardiovascular-Kidney-Metabolic (CKM) syndrome, spironolactone and empagliflozin. Prescribing trends were correlated with total search activity using Google Trends. ResultsWe found that finerenone was prescribed at a rate of 30,180 prescriptions/month in December 2022, increasing to 45,420 in December 2023, and 60,756 prescriptions/month in December 2024. This modest increase correlated with changes in Google search activity, with mild inflections after the release of major clinical trial data. The ratio of total prescriptions from nephrologists (15.81 prescriptions per nephrologist) to cardiologists (0.70 prescriptions per cardiologist) in 2024 was approximately 23:1. The proportion of finerenone prescriptions to other CKM therapies remained low, with finerenone prescriptions numerically representing 3.0% of empagliflozin prescriptions and 2.6% of spironolactone prescriptions in 2024. ConclusionThe adoption of finerenone has been modest, especially among cardiologists compared to nephrologists, and lags behind other CKM therapies. However, recent trends show an upward shift in its use that correlates with public interest related to clinical trial results.