BACKGROUND: The non-steroidal mineralocorticoid receptor antagonist finerenone 
(BAY 94-8862) has been used to treat chronic heart failure (CHF) with reduced 
ejection fraction (HFrEF). However, conflicting results were reported for its 
efficacy and safety. The study aimed to compare the efficacy and safety of 
finerenone versus spironolactone or eplerenone in patients with chronic heart 
failure.
METHODS: Electronic databases including MEDLINE, EMBASE, and CENTRAL were 
searched from inception to December 2017 for randomized controlled trials 
assessing finerenone treatment in patients with chronic heart failure. Data 
concerning the study's design, patients' characteristics, and outcomes were 
extracted. Risk ratio (RR) and mean differences (MD) were calculated using 
either fixed or random effects models.
RESULTS: Three trials with 1520 CHF patients were included in the systematic 
review. In terms of anti-ventricular remodeling, we calculated the effective 
number of cases with a 30% reduction in NT-proBNP. Finerenone was equivalent to 
the existing steroidal mineralocorticoid antagonist (P < .05). However, the 
efficacy of finerenone appeared to be dose-dependent. At a dose of 10 mg/d 
finerenone was found to be marginally better than that of steroidal 
mineralocorticoid receptor antagonists (MRAs) (RR = 1.18, 95% confidence 
interval [CI] 0.88, 1.57, P > .05). The incidence of treatment-related adverse 
events (TEAEs) of finerenone at 10 mg/d was significantly lower than 25 to 
50 mg/d of steroidal MRAs (RR = 0.81, 95% CI = 0.66-0.99, P = .04). Moreover, 
the serum potassium levels in the finerenone 10 mg/d group were lower than those 
in the 25 to 50 mg/d steroidal MRAs group (MD = -0.14, 95% CI -0.30-0.02, 
P = .09), whereas the estimated glomerular filtration rate (eGFR) was higher in 
finerenone versus steroidal MRAs treated patients (MD = 2.07, 95% CI -0.04-4.17, 
P = .05).
CONCLUSIONS: Finerenone reduced NT-proBNP level, urinary albumin/creatinine 
ratio (UACR), and other biochemical indicators, in a dose-dependent manner. In 
terms of anti-ventricular remodeling in patient with chronic heart failure, 
finerenone at 10 mg/d is as effective as 20 to 50 mg/d of steroidal MRAs. 
However, finerenone is much safer to patients with chronic kidney disease.