This study involves patients included in FINEARTS-HF, at the end of this trial.
In FINEARTS-HF, finerenone reduced the risk of cardiovascular death and worsening heart failure by 16%.
Although clinical practice guidelines recommend continuing heart failure treatments indefinitely, it is known that in practice there can be interruptions, particularly during hospitalisations. Additionally, both patients and physicians often question the possibility of treatment reduction in patients whose disease is stabilised, note Muthiah Vaduganathan of Harvard Medical School in Boston and colleagues.
There is little data on the consequences of stopping heart failure treatments. To fill this gap, the authors of FINEARTS-HF studied the 30-day period following treatment discontinuation in 3,742 patients from this study, whose average duration was 2.6 years. They compared this period to the 100 days preceding the discontinuation.
A significant increase in the risk of cardiovascular events was observed after stopping finerenone. While in the pre-discontinuation period, the event rate was 6 per 100 patient-years, it increased to 20.8 per 100 patient-years after discontinuation.
The risk of events - mainly hospitalisations related to heart failure - was thus multiplied by 2.8.
Conversely, in the placebo arm, the event risk was 9.2 per 100 patient-years before discontinuation (logically higher than the risk under finerenone since it showed efficacy in the study, Ed.) and remained statistically similar thereafter (11.2/100 patient-years).
The authors hypothesise that this rebound effect is due to the fact that under anti-aldosterone treatment, there is a compensatory mechanism of the body with an increase in circulating aldosterone. When the treatment stops, this excessive aldosterone level is no longer compensated by the drug, leading to rapid hemodynamic alterations and a deregulation of the salt and water balance.
They recall that in FINEARTS-HF, a positive effect was visible from the first 30 days of treatment with finerenone. It is therefore logical that a negative effect could be observed in a similar period after discontinuation.
"These results have important implications as short-term interruptions of mineralocorticoid receptor antagonists are relatively common in clinical practice, especially after hospitalisation for heart failure," and efforts are needed to "promote long-term persistence" of this treatment, the authors conclude. "Minimal changes in potassium concentration or renal function during treatment should not automatically lead to discontinuation."
(JACC)
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