Efficacy of finerenone in reducing proteinuria in diabetic kidney disease on dapagliflozin and telmisartan: A disease-modifying approach

Table 2 Comparison of third-generation non-steroidal mineralocorticoid receptor antagonists

Characteristic features	Finerenone	Esaxerenone	Apararenone (MT-3995)
Primary clinical indication	Diabetic kidney disease (2021-Food and Drug Administration of the United States, 2022-European Medicines Agency)	Hypertension; diabetic nephropathy (Japan)[45]	Diabetic nephropathy (investigational)[46]
Relative potency in MR antagonism to Spironolactone	Similar. Specific affinity for MR receptor	Higher	Lesser
Half-life (t1/2). Active metabolites	2-3 hours. None	30 hours. Not clinically relevant	275-285 hours
Tissue distribution (rodent studies)[41]	Balanced (heart = kidney)	Balanced (heart = kidney)	Balanced (heart = kidney)
BP lowering effect	Modest	Potent	Potent
Hyperkalemia risk	Less compared to steroidal MRA. Can start when blood potassium ≤ 4.8 - > 5.0 mmol/L	higher rate compared with eplerenone (ESAX-HTN)[44]	Minor risk
Blood-brain barrier	Does not cross	Crosses	Likely crosses
Dose schedule	eGFR ≥ 60 mL/minute/1.73 m2: 20 mg/day; eGFR 25-59 mL/minute/1.73 m2: 10 mg/day; eGFR < 25 mL/minute/1.73 m2: Not recommended	1.25-2.5 mg/day	2.5, 5, 10 mg/day

BP: Blood pressure; eGFR: Estimated glomerular filtration rate; MRA: Mineralocorticoid receptor antagonists.