Finerenone (Kerendia) is a new drug that is prescribed to slow the progression of chronic kidney disease and the risk of cardiovascular death, non-fatal heart attack, and hospitalization for heart failure in adult patients with chronic kidney disease associated with type 2 diabetes. The retail price of finerenone is $742 a month. Eplerenone retail cost is $83 a month. You can get it at Walmart with a coupon for less than $10 a month. Spironolactone is $4 a month cash price at Walmart. These drugs all have the same impact. If you look at upper right corner of the diagram below, you can see that aldosterone damages organs and vessels by engaging the MR receptor and increasing oxidant production. Excess oxidants leads to inflammation, scar tissue growth, and death of the important cells in the heart, kidney, and liver that are responsible for organ function. These drugs engage the MR receptor and block the effects of aldosterone. If you break off a key in a lock, you can’t get another key in to open the door. These drugs all block the MR receptor and are underused. They are highly effective precision medicines.
If a patient has more severe chronic kidney disease, that is the place where finerenone may be worth the huge difference in price. It is less likely to cause a further reduction in kidney function and potassium accumulation than spironolactone or eplerenone. Both problems can be dangerous. If you still have half your kidney function, you can use lower dose spironolactone or eplerenone while monitoring kidney function and potassium levels closely. I have even given 12.5 mg of spironolactone every other day. Spironolactone components last a long time. It is smart to use very small doses less frequently to see if it is well tolerated. This is a drug that is usually taken for the rest of our lives and often it can be used safely for a tiny fraction of the cost. Spironolactone also has some sex hormone side effects at higher doses. It can cause breast enlargement and impotence. That is a problem for male patients with larger doses. I can afford eplerenone which is much more precise and has no extra problems for men. That is what I take.
This is a great example of too little too late! People who have extra abdominal fat make too much aldosterone and that leads to high blood pressure, insulin resistance, higher sugar levels, and organ damage. By using spironolactone or eplerenone much earlier to treat high blood pressure or diabetic complications when kidney function is normal, we can protect the kidney and dramatically slow progression to chronic kidney disease. Blocking the effects of aldosterone is especially effective in high blood pressure that does not respond well to treatment.
So, why all the fuss about finerenone? What about these landmark studies? They are boasting about a reduction in nonfatal heart attack, nonfatal stroke, cardiovascular death, and hospitalization for heart failure by thirteen or fourteen percent compared with usual care in patients with diabetes. It reduced a 40% reduction in kidney function by about the same amount. That is the reason these drugs should be tested against best practice medical treatment or optimal medical therapy (OMT). Best practice medical treatment combines lisinopril or losartan for high blood pressure, atorvastatin for cholesterol, and metformin for high sugar, diet, and exercise in patients with type 2 diabetes who already have chronic kidney disease. Patients in usual care have 4 times as many heart attacks, 5 times as many strokes, and 6 times as many people go on dialysis for kidney failure compared with patients on OMT. This comprehensive approach to increased cardiovascular risk is thirty times as effective compared with adding finerenone to usual care. Adding spironolactone or eplerenone to OMT would make it even more effective. Eplerenone alone lowers the risk of cardiovascular death and hospitalization related to heart failure by 30%. That is a similar level of impact as finerenone at a fraction of the cost.
MR blockers are dramatically underused. They are antioxidants that work to protect every cell and organ in the body. By understanding the nuances in these drugs, you can provide their tremendous benefits at very reasonable cost. The key is using the less expensive drugs earlier to block fundamental mechanisms of chronic illness precisely. When they are used before chronic kidney disease develops they are as safe as finerenone. Finerenone is a worthwhile addition in patients with more advanced kidney disease. Beyond that it is about the same bang for a lot more buck! You can buy the entire OMT protocol for between $30 and $40 without health insurance.
Generic drugs like lisinopril, losartan, eplerenone, spironolactone, atorvastatin, and metformin are proven precision drugs like finerenone that have a tremendous impact on clinical and financial outcomes. These medications combined with diet and exercise in an evidence-based protocol consistent with best practices are much more effective than finerenone at much lower cost. There are just a half dozen generic medicines that have those powerful effects on heart disease, diabetes, and related conditions. That approach reduces death from all causes. We can have better health at lower cost, but we can’t do it without your help. Ads that promote expensive brand name drugs when a ten-dollar drug will do make medical care more expensive for everyone. Someone pays hundreds of dollars more for finerenone. The more you know, the better health you can have and you can pay less for it.
Thanks again, dr Bestermann. My husband has kidney issues and has in the past had a mild stroke and triple bypass. He is not diabetic. Your postings will be my go to for sensible treatments. He will read yours if I give them to him but not too often. 🙄🤔. LOL.
Thank you again. You also point out that we have lost common sense. But I wonder 💭 if some knew however profit matters more.