Finerenone Prescriptions in the United States (2021–2024) by Physician Specialty: Analysis of Use and Potential in the Cardiovascular-Kidney-Metabolic Space

BACKGROUND: Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, has demonstrated greater receptor selectivity and fewer adverse effects compared with 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 used in clinical practice. METHODS: A serial, cross-sectional analysis of IQVIA’s National Prescription Audit, which covers >70% of US 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 with those of 2 other medications with related mechanisms or indications commonly used in cardiovascular-kidney-metabolic syndrome, spironolactone and empagliflozin. Prescribing trends were correlated with total search activity using Google Trends. RESULTS: We found that finerenone was prescribed at a rate of 30 180 prescriptions/month in December 2022, increasing to 45 420 prescriptions/month in December 2023, and to 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)/cardiologists (0.70 prescriptions per cardiologist) in 2024 was ≈23:1. The proportion of finerenone prescriptions to other cardiovascular-kidney-metabolic therapies remained low, with finerenone prescriptions numerically representing 3.0% of empagliflozin prescriptions and 2.6% of spironolactone prescriptions in 2024. CONCLUSIONS: The adoption of finerenone has been modest, especially among cardiologists compared with nephrologists, and lags behind other cardiovascular-kidney-metabolic therapies. However, recent trends show an upward shift in its use that correlates with public interest related to clinical trial results.