Finerenone for Pediatric Chronic Kidney Disease

(FIONA OLE Trial)

Recruiting at192 trial locations

Age: < 65

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 3

Recruiting

Sponsor: Bayer

Must be taking: ACEI, ARB

Must not be taking: MRAs, Renin inhibitors

Disqualifiers: Planned urological surgery, Renal transplantation, Hypertension, others

No Placebo Group

Pivotal Trial (Near Approval)

Prior Safety Data

Approved in 2 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial tests finerenone, a new medication added to existing treatments, to help children with chronic kidney disease (CKD) and proteinuria. It aims to see if finerenone can better control kidney function and reduce protein in the urine. The study will monitor safety and effectiveness over several months. Finerenone has been shown to delay the progression of chronic kidney disease.

Will I have to stop taking my current medications?

The trial requires participants to continue taking either an ACEI or ARB at stable doses, but you cannot take certain other medications like mineralocorticoid receptor antagonists or SGLT2 inhibitors. The protocol does not specify a need to stop other medications, but you should discuss your current medications with the study team.

What data supports the effectiveness of the drug Finerenone for pediatric chronic kidney disease?

Finerenone has been shown to help adults with chronic kidney disease and type 2 diabetes by reducing the risk of kidney function decline and heart-related issues. While this data is for adults, it suggests potential benefits for kidney health that might be relevant for children with chronic kidney disease. ^{1 2 3 4 5}

How does the drug Finerenone differ from other treatments for pediatric chronic kidney disease?

Finerenone is unique because it is a non-steroidal mineralocorticoid receptor antagonist, which means it works by blocking certain receptors in the body that can contribute to kidney damage, offering a different mechanism of action compared to traditional treatments like dialysis or transplantation. ^{6 7 8 9 10}

Research Team

Eligibility Criteria

This trial is for children and young adults aged 1 to 18 with chronic kidney disease (CKD) and proteinuria. They must have been part of the FIONA study, not planning a kidney transplant soon, not have severe high blood pressure or liver issues, and be on stable doses of ACE inhibitors or ARBs. Kids under 2 should have potassium levels ≤5.3 mmol/L; older kids ≤5.0 mmol/L.

Inclusion Criteria

I am between 1 and 18 years old.

You have previously taken part in the finerenone Phase 3 study FIONA (19920) and did not stop the treatment permanently by the end of the study.

I can eat solid food or receive nutrition through a feeding tube.

Exclusion Criteria

Previous assignment to treatment during this study

I am currently taking specific heart or blood pressure medications.

I have low blood pressure according to my age, sex, and height.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive finerenone in addition to an ACEI or ARB for up to 18 months to assess safety and efficacy in controlling RAAS overactivation

18 months

At least 12 visits for new participants, at least 8 visits for those previously on finerenone

Follow-up

Participants are monitored for safety and effectiveness after treatment, including health checks 30 days post-treatment

1 month

Treatment Details

Interventions

• Finerenone (Mineralocorticoid Receptor Antagonist)

Trial Overview The trial tests the safety of finerenone when taken alongside an ACE inhibitor or ARB over 18 months in managing CKD and proteinuria in children. It will monitor adverse events, potassium levels, blood pressure, urine protein levels (UACR & UPCR), serum creatinine, and estimated glomerular filtration rate (eGFR).

Participant Groups

Group I: Finerenone Open-Label safety Extension Experimental Treatment 1 Intervention

Participants will receive finerenone treatment.

Who Is Running the Clinical Trial?

Bayer

Lead Sponsor

Trials

2,291

Recruited

25,560,000+

Founded

1863

Headquarters

Leverkusen, Germany

Known For

Pharmaceutical Innovations

Top Products

Aspirin, Aleve, Yaz, Nexavar

Bill Anderson

Bayer

Chief Executive Officer since 2023

BSc in Chemical Engineering from the University of Texas, MSc in Chemical Engineering and Management from MIT

Michael Devoy

Bayer

Chief Medical Officer since 2014

MD, PhD

Findings from Research

Finerenone is a first-in-class oral medication that selectively targets mineralocorticoid receptors, approved in the USA for reducing the risk of serious complications like kidney decline and heart issues in adults with chronic kidney disease related to type 2 diabetes.

It has shown efficacy in preventing sustained declines in kidney function and reducing cardiovascular risks, and is currently being studied in a phase III trial for heart failure with preserved ejection fraction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Finerenone: First Approval. Frampton, JE.[2022]

In a study of 13,026 patients with chronic kidney disease (CKD) and type 2 diabetes, finerenone showed similar efficacy in reducing cardiovascular and kidney-related events in Hispanic patients compared to non-Hispanic patients, with a notable 20% reduction in cardiovascular events for those on finerenone.

Finerenone also significantly reduced urinary albumin-to-creatinine ratio (UACR) by 32% at month 4 in both Hispanic and non-Hispanic patients, indicating its effectiveness in improving kidney function, while maintaining a similar safety profile across both groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Finerenone in Hispanic Patients With CKD and Type 2 Diabetes: A Post Hoc FIDELITY Analysis. Rosas, SE., Ruilope, LM., Anker, SD., et al.[2023]

Finerenone (Kerendia) is approved for reducing the risk of serious kidney and cardiovascular issues in adults with chronic kidney disease linked to type 2 diabetes.

The medication specifically targets the decline in kidney function and helps prevent complications such as heart failure and heart attacks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

New Type 2 Diabetes Drug AIMS to Reduce Risk of Diminished Kidney Function and Cardiovascular Complications. Aschenbrenner, DS.[2023]

Finerenone, a new non-steroidal mineralocorticoid antagonist, shows better renal outcomes compared to spironolactone and improved mortality outcomes compared to eplerenone in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D), with fewer instances of hyperkalemia.

In long-term studies, finerenone significantly reduces the progression of renal disease and cardiovascular events, particularly heart failure hospitalizations, without affecting HbA1c, body weight, or causing sexual side effects, although it does have a higher rate of hyperkalemia leading to drug withdrawal compared to placebo.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Finerenone in diabetic kidney disease: A systematic review and critical appraisal. Singh, AK., Singh, A., Singh, R., et al.[2022]

In a study of 13,026 patients with chronic kidney disease (CKD) and type 2 diabetes (T2D), finerenone showed similar efficacy in reducing cardiovascular and kidney-related complications in both Black (4.0% of participants) and non-Black patients, indicating its effectiveness across diverse populations.

Finerenone significantly reduced the urine albumin-to-creatinine ratio by 40% in Black patients and slowed chronic eGFR decline, demonstrating its potential to protect kidney function and cardiovascular health in patients with CKD and T2D.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Finerenone in Black Patients With Type 2 Diabetes and CKD: A Post hoc Analysis of the Pooled FIDELIO-DKD and FIGARO-DKD Trials. Flack, JM., Agarwal, R., Anker, SD., et al.[2023]

The incidence of children under 15 starting kidney replacement therapy (KRT) in Europe remained stable from 2007 to 2016, ranging between 5.5 and 6.6 per million age-related population, indicating consistent rates of new cases.

The prevalence of KRT among children increased by 2% annually, with a notable rise in kidney transplantation and peritoneal dialysis, while five-year patient survival rates remained high at around 94%, showing effective long-term outcomes for pediatric patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ten-year trends in epidemiology and outcomes of pediatric kidney replacement therapy in Europe: data from the ESPN/ERA-EDTA Registry. Bonthuis, M., Vidal, E., Bjerre, A., et al.[2023]

The prevalence of renal replacement therapy (RRT) in children has significantly increased from 22.9 per million in 1980 to 62.1 per million in 2000, while the incidence has stabilized at around 9.9 per million since 1985.

Patient survival rates have improved, with a 36% reduction in the risk of death for dialysis patients and a 42% reduction for transplant recipients starting treatment between 1995 and 2000 compared to those starting between 1980 and 1984.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Renal replacement therapy in children: data from 12 registries in Europe. van der Heijden, BJ., van Dijk, PC., Verrier-Jones, K., et al.[2018]

In a study of 807 pediatric patients under 16 years old on chronic peritoneal dialysis (PD), the survival rates were high, with 91% surviving after 3 years and 86% after 5 years, indicating the efficacy of PD as a treatment option.

However, younger children (under 6 years) had poorer outcomes, highlighting the need for careful management in this age group, as they experienced higher rates of complications and lower survival rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The 1997 Report of the Japanese National Registry data on pediatric peritoneal dialysis patients. Honda, M.[2020]

The ESPN/ERA Registry has been collecting valuable data on children with chronic kidney disease (CKD) undergoing kidney replacement therapy since 2007, highlighting the need for ongoing research in this challenging area.

A recent survey identified eight existing CKD registries across 38 European countries, suggesting a promising opportunity to link these registries to better monitor disease progression and improve patient outcomes in children with CKD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

European chronic kidney disease registries for children not on kidney replacement therapy: tools for improving health systems and patient-centred outcomes. Bakkaloğlu, SA., Vidal, E., Bonthuis, M., et al.[2023]

In a study of 558 children with chronic kidney disease (CKD), it was found that the number of medications prescribed for comorbidities increased significantly with more advanced CKD stages and specific kidney disease types, indicating a complex treatment landscape.

Nonadherence to medication was linked to the frequency of dosing rather than the total number of medications, suggesting that simplifying treatment regimens could help improve adherence in pediatric CKD patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Medication treatment complexity and adherence in children with CKD. Blydt-Hansen, TD., Pierce, CB., Cai, Y., et al.[2021]

References

1. New Zealand pubmed.ncbi.nlm.nih.gov

Finerenone: First Approval. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Finerenone in Hispanic Patients With CKD and Type 2 Diabetes: A Post Hoc FIDELITY Analysis. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

New Type 2 Diabetes Drug AIMS to Reduce Risk of Diminished Kidney Function and Cardiovascular Complications. [2023]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Finerenone in diabetic kidney disease: A systematic review and critical appraisal. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Finerenone in Black Patients With Type 2 Diabetes and CKD: A Post hoc Analysis of the Pooled FIDELIO-DKD and FIGARO-DKD Trials. [2023]

6. Germany pubmed.ncbi.nlm.nih.gov

Ten-year trends in epidemiology and outcomes of pediatric kidney replacement therapy in Europe: data from the ESPN/ERA-EDTA Registry. [2023]

7. Germany pubmed.ncbi.nlm.nih.gov

Renal replacement therapy in children: data from 12 registries in Europe. [2018]

8. United States pubmed.ncbi.nlm.nih.gov

The 1997 Report of the Japanese National Registry data on pediatric peritoneal dialysis patients. [2020]

9. England pubmed.ncbi.nlm.nih.gov

European chronic kidney disease registries for children not on kidney replacement therapy: tools for improving health systems and patient-centred outcomes. [2023]

10. United States pubmed.ncbi.nlm.nih.gov

Medication treatment complexity and adherence in children with CKD. [2021]