Adrenal (Excluding Mineralocorticoids)

SUN-429 - Long-Term Effectiveness and Safety of Finerenone Versus Spironolactone in Patients with Primary Aldosteronism in China: A Real-World Multicenter Prospective Cohort Study

Sunday, June 14, 2026

9:00 AM - 4:00 PM CT

Location: ENDOExpo; Poster Floor

Abstract Poster Presenter(s)

FY

Fan Yang, Dr

Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University
Nanjing, China (People's Republic)

Co-Author(s)

YL

Yuxing Lou, MB

Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine
Nanjing, China (People's Republic)
ZZ

Ziwei Zhang, MD

Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University
Nanjing, China (People's Republic)
YD

Yunfeng Du, MD

The Second People's Hospital of Changzhou, the Third Affiliated Hospital of Nanjing Medical University
Changzhou, China (People's Republic)
JZ

Jie Zhang, MD

The Second People's Hospital of Changzhou, the Third Affiliated Hospital of Nanjing Medical University
Changzhou, China (People's Republic)
YR

Yan Ren, MD

Department of Endocrinology, West China Hospital, Sichuan University
Chengdu, China (People's Republic)
AT

Anli Tong, MD

Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission of the People's Republic of China, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences
Beijing, China (People's Republic)
ZX

Zuoling Xie, MD

Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University
Nanjing, China (People's Republic)
BS

Bimin Shi, MD

Department of Endocrinology, The First Affiliated Hospital of Soochow University
Suzhou, China (People's Republic)
JL

Jianping Liu, MD

Department of Endocrinology and Metabolism of the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University
Nanchang, China (People's Republic)
LL

Libin Liu, MD

Department of Endocrinology, Fujian Medical University Union Hospital
Fuzhou, China (People's Republic)

Senior Author/Primary Investigator(s)

DZ

Dalong Zhu, MD

Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University
Nanjing, China (People's Republic)
PL

Ping Li, MD

Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University
Nanjing, China (People's Republic)

Background:
Finerenone, a novel nonsteroidal mineralocorticoid receptor antagonist (MRA), has demonstrated short-term efficacy and safety in patients with primary aldosteronism (PA). However, evidence for its long-term effectiveness and safety versus spironolactone in real-world settings remains scarce.

Aim:
To compare the long-term effectiveness and safety of treatment strategies centered on finerenone versus spironolactone in PA patients in a real-world setting.

Methods:
The multicenter prospective cohort included PA patients from eight hospitals in China who had completed a prior single-arm trial of finerenone. According to the actual treatment during follow-up (>6 months), the patients were categorized into finerenone continuation (FIN) or spironolactone switch (SPI) groups. Concomitant antihypertensive therapy followed routine practice. The primary endpoint was the integrated control rate (office BP < 140/90 mmHg and normokalemia without potassium supplementation). Secondary endpoints included changes in ambulatory and office BP parameters, plasma renin activity (PRA), Primary Aldosteronism Medical Treatment Outcome (PAMO) response rates, and adverse events. Multivariable models were adjusted for baseline and defined daily dose (DDD) changes.

Results:
A total of 37 PA patients were included (FIN: 26; SPI: 11) and received mean daily doses of 21.9 mg of finerenone or 40 mg of spironolactone, respectively. Baseline characteristics were comparable between the groups. Primary endpoint: After adjustment for the DDD, no significant difference in integrated control rate was observed (FIN: 53.8% vs. SPI: 63.6%; adjusted OR=0.289; 95% CI 0.039–2.127; p=0.223). Secondary endpoints: Office BP decreased significantly in both groups (FIN: -15.4/-10.0 mmHg; SPI: -19.9/-10.9 mmHg; adjusted p>0.05 between groups). Daytime systolic BP decreased similarly (FIN: 11.0 mmHg; SPI: 13.7 mmHg; adjusted p=0.677). No significant differences were observed in posttreatment serum potassium concentrations (FIN: 4.06 mmol/L vs. SPI: 4.10 mmol/L; p=0.611) or PRA (FIN: 0.41 [0.14–1.01] ng/mL/h vs. SPI: 0.53 [0.09–1.11] ng/mL/h; p=0.088). The PAMO complete biochemical (23.1% vs. 27.3%; adjusted p=0.179) and clinical (11.5% vs. 9.1%; adjusted p=0.772) response rates were comparable. No gonadal adverse events occurred in the FIN group; 3 cases of breast pain (27.3%) were reported in the SPI group (p=0.021). No hyperkalemia occurred, and eGFR remained stable in both groups.

Conclusion:
This real-world study indicates that finerenone- and spironolactone-based strategies demonstrate similar efficacy against PA in terms of long-term blood pressure control, biochemical improvement, and PAMO response. Furthermore, finerenone is not associated with gonad-related adverse effects. This study extends the evidence and supports the use of finerenone in the management of PA.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*