eplerenone / Generic mfg. - LARVOL DELTA

Practical Implementation of Steroidal and Nonsteroidal Mineralocorticoid Receptor Antagonists in the Management of Heart Failure. (PubMed, JACC Adv) - "The nonsteroidal MRA finerenone has demonstrated efficacy in this population and was approved for treatment in July 2025 by the U.S. Food and Drug Administration...Guideline recommendations and HF label indications are discussed, highlighting practical considerations for the safe use of MRAs in clinical practice. In addition, the therapeutic management of patients with HFmrEF/HFpEF and concomitant cardiovascular, kidney, and metabolic diseases is considered."

Journal • Cardiovascular • Congestive Heart Failure • Heart Failure • Metabolic Disorders

Serum Potassium and Mineralocorticoid Receptor Antagonists As Modifiers of Atrial Arrhythmia Recurrence After Catheter Ablation for Atrial Fibrillation: A Narrative Review With Systematic Search and Mechanistic Synthesis. (PubMed, Cureus) - "We aimed to synthesize the clinical and mechanistic evidence on whether serum potassium, potassium-management strategies, and MRA therapy (steroidal: spironolactone, eplerenone; nonsteroidal: esaxerenone, finerenone) modify recurrence, and to derive a testable mechanistic framework. Current evidence supports avoiding hypokalemia and hyperkalemia, correcting reversible disturbances, and prescribing MRAs for established indications with appropriate monitoring; it does not justify routine potassium supplementation or MRA use solely to prevent post-ablation recurrence. Prospective, adequately powered randomized studies with longitudinal potassium assessment and rigorous rhythm monitoring are required before mechanism-based post-ablation interventions can be recommended."

Journal • Review • Atrial Fibrillation • Cardiovascular • Immunology

Real-World Utilisation and Cost Trends of Mineralocorticoid Receptor Antagonists in England: A Population-Level Prescribing Analysis From 2022 to 2025. (PubMed, Cardiovasc Ther) - "Spironolactone remained the most frequently dispensed MRA in England between 2022 and 2025. Eplerenone utilisation increased, whereas its cost per item declined markedly by 2025, and finerenone showed rapid uptake from a very low baseline while retaining the highest cost per item. These descriptive findings identify changing utilisation and expenditure patterns but do not establish indication-specific use, comparative effectiveness, safety, adherence or cost-effectiveness and should be considered hypothesis-generating."

Journal • Observational data • Real-world evidence • Retrospective data • Cardiovascular • Nephrology • Renal Disease

Early mineralocorticoid receptor antagonism for end-organ protection in hypertension: Implications for disparities and rethinking the timing paradigm. (PubMed, Dialogues Health) - "We searched PubMed/MEDLINE and the Cochrane Library (inception-July 2026) using terms including mineralocorticoid receptor antagonist, aldosterone, spironolactone, eplerenone, finerenone, hypertension, resistant hypertension, end-organ damage, fibrosis, hyperkalemia, chronic kidney disease, heart failure, and health disparities. In selected higher-risk patients with preserved renal function and controlled potassium, earlier MR antagonism may warrant prospective evaluation as a tissue-protective, disparity-reducing strategy. This framework is hypothesis-generating and is intended to stimulate research, not to alter current guideline-directed therapy."

Journal • Review • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Fibrosis • Heart Failure • Hypertension • Immunology • Inflammation • Nephrology • Renal Disease

GPER and EGFR cross-talk highlight aldosterone- and MR antagonist-induced NO production in cultured endothelial cells. (PubMed, Front Pharmacol) - "All three MR antagonists blocked the aldosterone responses, yet each also evoked intrinsic, concentration-dependent NO production in the absence of aldosterone, eplerenone and spironolactone showing greater intrinsic efficacy than finerenone. Pretreatment with 100 nM of the GPER antagonist G-36 or 100 nM AG-1478 significantly reduced both aldosterone-induced DAF-NO signaling and vasodilation, whereas endothelium removal or L-NAME converted vasodilation into vasoconstriction...Because recent cryo-EM work reveals a non-canonical extracellular GPER architecture, the docking results are interpreted as structurally plausible interaction scenarios rather than definitive orthosteric assignments; whether the behaviour reflects direct partial agonism at GPER or an indirect, GPER-dependent mechanism remains to be established by direct-binding studies. These findings expand current understanding of MR antagonist pharmacology."

Journal • Cardiovascular • EGFR

Comparative Efficacy of Aldosterone-Related Sodium-Retention Pathway Therapies for Resistant Hypertension: A Drug-Level Network Meta-Analysis of Randomized Controlled Trials. (PubMed, J Clin Hypertens (Greenwich)) - "In the primary drug-level analysis, amiloride, spironolactone, baxdrostat, eplerenone, and lorundrostat significantly reduced office systolic BP compared with placebo, with mean differences (MDs) of -14.08, -10.78, -9.09, -8.14, and -6.80 mmHg, respectively. Osilodrostat showed a statistically uncertain effect, with an MD of -2.61 mmHg...MRAs remain the established reference add-on therapy, whereas newer ASIs and amiloride may represent pathway-based alternatives for selected patients. Trial Registration: INPLASY202670099."

Clinical • Journal • Retrospective data • Cardiovascular • Hypertension

KT-CANOPY: Cardiac Improvement by Eplerenone Among Patients Under Cyclosporine or Tacrolimus for Kidney Transplantation. (clinicaltrials.gov) - P3 | N=132 | Not yet recruiting | Sponsor: Central Hospital, Nancy, France

New P3 trial • Transplantation

EPLERENONE VS SPIRONOLACTONE IN HEART FAILURE WITH PRESERVED EJECTION FRACTION (HFPEF): A PROPENSITY-MATCHED REAL-WORLD OUTCOMES ANALYSIS (CHEST 2026) - No abstract available

Clinical • Real-world • Real-world evidence • Cardiovascular • Congestive Heart Failure • Heart Failure

Estimating the Benefits of the Comprehensive Disease-modifying Pharmacological Treatment in Patients with Heart Failure. (PubMed, Card Fail Rev) - "The numbers needed to treat per year for the primary outcome, cardiovascular death and first heart failure hospitalisation were 10, 23 and 15, respectively. Our findings support the potential benefit of comprehensive therapy, with the incremental role of vericiguat likely greatest in higher-risk patients or those with recent worsening heart failure."

Journal • Review • Cardiovascular • Congestive Heart Failure • Heart Failure

Discharge Use of Mineralocorticoid Receptor Antagonists and Long-Term Outcomes in HFpEF. (PubMed, J Cardiol) - "In patients with preserved ejection fraction discharged after ADHF, MRA use at discharge was associated with a lower hazard of the composite of all-cause death or HF rehospitalization."

Journal • Cardiovascular • Congestive Heart Failure • Heart Failure

PRO/CON debate: nonsteroidal versus steroidal mineralocorticoid receptor antagonists in chronic kidney disease: progress, pragmatism, and remaining uncertainties. (PubMed, Clin Kidney J) - "Classic steroidal MRAs, spironolactone and eplerenone, have long been used to treat hypertension and heart failure and to reduce albuminuria, but their wider use in CKD has been constrained by hyperkalaemia and endocrine side-effects. Nonsteroidal MRAs (nsMRAs), typified by finerenone, were developed to maintain antiproteinuric and antifibrotic efficacy while improving tissue selectivity, pharmacokinetics, and tolerability...At the same time, the superior blood pressure-lowering capacity, low cost, and global availability of steroidal MRAs remain compelling, particularly in resistant hypertension and resource-constrained settings. This pro/con debate contrasts the case for nsMRAs with that for classic steroidal MRAs and explores how best to deploy each class across heterogeneous CKD populations."

Journal • Review • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Diabetes • Heart Failure • Hypertension • Metabolic Disorders • Nephrology • Renal Disease • Type 2 Diabetes Mellitus

Inflammation of the calcified aortic valve in cardiac patients is associated with activation of the local aldosterone system, promoting oxidative stress–driven pathological responses (ESC 2026) - "In PBMCs, glucose uptake was quantified using 2-NBDG, and aldosterone release by ELISA. ROS levels were increased 1.7-fold in calcified aortic valve regions compared with non-calcified areas, and this augmented oxidative activity was significantly attenuated by NAC, losartan, VAS-2870, empagliflozin, eplerenone, and FAD286. Aldosterone synthase is upregulated in calcified aortic valves, particularly within infiltrating macrophages, and promotes pro-oxidant and metabolic dysregulation in both valve tissue and PBMCs. These findings suggest that aldosterone signaling contributes to the progression of calcified aortic stenosis and represents a potential therapeutic target."

Clinical • Oxidative stress • Cardiovascular • Heart Failure • CD68

Comparative effectiveness of GLP-1 receptor agonists versus mineralocorticoid receptor antagonists as fourth-line pharmacological therapy in patients with resistant hypertension and overweight or obesity: a retrospective multicenter cohort study in the USA. (PubMed, EClinicalMedicine) - "Patients initiating GLP-1RAs (semaglutide or tirzepatide) were compared with those initiating MRAs (spironolactone or eplerenone). Prospective studies are needed to determine whether GLP-1RAs should be incorporated into treatment strategies for resistant hypertension in patients with overweight or obesity. None."

HEOR • Journal • Retrospective data • Acute Kidney Injury • Cardiovascular • Genetic Disorders • Hypertension • Nephrology • Obesity • Renal Disease

Eplerenone vs. spironolactone in heart failure: long-term cardiorenal and mortality outcomes in a registry-based cohort. (PubMed, Eur Heart J Cardiovasc Pharmacother) - "Compared with spironolactone, eplerenone was associated with lower all-cause mortality and lower risks of kidney function decline and mild hyperkalaemia. These observational findings warrant confirmation in randomized comparisons."

Journal • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Heart Failure

Eplerenone vs. spironolactone in heart failure: a propensity score-matched analysis of 77 904 patients from a global federated network. (PubMed, J Cardiovasc Med (Hagerstown)) - "In this large propensity score-matched cohort, eplerenone was associated with lower mortality, MACE, and CKD progression than spironolactone overall and in HFrEF. In HFpEF, spironolactone was favoured for MACE and heart failure hospitalization, with no significant difference in mortality. These hypothesis-generating findings support prospective head-to-head trials."

Clinical • Journal • Observational data • Retrospective data • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Heart Failure • Nephrology • Renal Disease

Comparative Safety Of Spironolactone Versus Eplerenone In Heart Failure With Reduced Ejection Fraction: A Propensity Score-Matched Cohort Study (HFSA 2026) - "Spironolactone and eplerenone demonstrate comparable short-term safety in contemporary HFrEF practice with high SGLT2 inhibitor co-therapy. These findings support cost-based MRA selection.Figure. Forest plot comparing primary safety outcomes between spironolactone and eplerenone in propensity-matched HFrEF patients (n=2,524)."

Clinical • Acute Kidney Injury • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Diabetes • Heart Failure • Hypertension • Hypotension • Metabolic Disorders • Nephrology • Renal Disease

Comparative Effectiveness Of Finerenone, Spironolactone, And Eplerenone Across Heart Failure Spectrum: A Network Meta-analysis [Poster no. 228] (HFSA 2026) - No abstract available

HEOR • Retrospective data • Cardiovascular • Congestive Heart Failure • Heart Failure

Modulation of mineralocorticoid receptor protects tributyltin chloride-induced early neurotoxic anomalies in rats. (PubMed, Indian J Pharmacol) - "TBTC induced early neurotoxic changes in the brain, which were attenuated by NAC and eplerenone administration. The beneficial effects support for further mechanistic studies on mineralocorticoid receptor modulation as a potential target for OT-induced neurotoxicity."

Journal • Preclinical • Mental Retardation • Mood Disorders • Psychiatry

Antiatopic dermatitis activity of Lissachatina fulica mucin: Network pharmacology analysis and experimental validation. (PubMed, Turk J Biol) - "A total of 60 BALB/c mice were sensitized on the dorsal skin with 1% 2,4-dinitrochlorobenzene and subsequently treated with dexamethasone or LFM cream (5% or 10%), which was applied daily for 7 days...The NP analysis identified three major bioactive compounds in LFM-macamide, N-benzyloleamide, and a compound tentatively annotated as eplerenone-that potentially targeted CCL2 and TNF, which may serve as key regulators associated with the anti-AD effects of LFM...LFM demonstrated potential anti-AD effects by modulating CCL2- and TNF-associated pathways. LFM 5% cream reduced ADSI scores and IL-1β expression while normalizing epidermal thickness, potentially through immunomodulatory responses during the skin recovery phase."

Journal • Atopic Dermatitis • Dermatitis • Dermatology • Immunology • Inflammation • AKT1 • CCL2 • ICAM1 • IL1B • MMP9 • PACERR • PTGS2 • SYK

Heart failure therapy optimization in myocardial infarction patients with systolic dysfunction during Phase 2 and 3 Cardiac Rehabilitation (ESC 2026) - "A trend toward reduced use of ACEI (32.2% to 25.3%) and ARB (28.7% to 23%) was observed, accompanied by a significant increase in ARNI use (25.3% to 41.4%) and ED (from 1 [0.5-1] to 1 [0.5-2] sacubitril-valsartan 24/26mg ED, p<0.001). Both the use and ED of MRA increased (39.1% and 1 [0.5-1] to 73.6% and 1 [1-1] eplerenone 25mg ED, p<0.001)...However, most patients do not reach guideline-recommended target doses, potentially due to symptomatic hypotension or LVEF recovery. The clinical implications of this treatment strategy warrant further investigation."

Clinical • P2 data • Cardiovascular • Congestive Heart Failure • Heart Failure • Hypotension • Myocardial Infarction

The effect of eplerenone vs irbesartan as first line therapy in obese hypertensive patients on left ventricular hypertrophy and diastolic dysfunction: echocardiographic results of the HEBRO randomized (ESC 2026) - "At 2 months and 4 months up-titration with amlodipine 5mg and indapamide 1.5mg respectively was taken place when mean ambulatory BP (ABPM) was over 130/80mmHg. The number of antihypertensive drugs was 1.8 ± 0.8 vs 1.9 ± 0.8, p=0.164.ConclusionsEchocardiographic assessment demonstrated that both irbesartan and eplerenone were associated with significant regression of left ventricular mass and improvement in diastolic function parameters over the 6-month follow-up period, with no significant difference between treatment groups in terms of LVMI reduction. Notably, eplerenone was associated with a significantly greater reduction in left atrial volume index compared with irbesartan, indicating a more pronounced effect on left atrial remodeling."

Clinical • Cardiovascular • Hypertension

Finerenone versus spironolactone in HFpEF patients with type 2 diabetes and CKD: a real-world comparative analysis (ESC 2026) - "Methods Using the TriNetX Global Collaborative Network (166 healthcare organizations), we identified adults (≥18 years) with HFpEF between January 1, 2015, and December 31, 2025, who initiated spironolactone (25–50 mg; excluding eplerenone/finerenone) or finerenone (excluding spironolactone/eplerenone). Ischemic outcomes (MI, stroke) were comparable. These findings support further prospective evaluation of finerenone as a potentially safer and more effective MRA strategy in this high-risk HFpEF population."

Clinical • Real-world • Real-world evidence • Cardiovascular • Congestive Heart Failure • Heart Failure • Myocardial Infarction

Comparative effectiveness of mineralocorticoid receptor antagonists in cardiorenal and metabolic disease (ESC 2026) - " Utilizing the TriNetX global health research network, we identified adults initiating spironolactone, eplerenone, or finerenone (the latter in conjunction with SGLT2 inhibitors). While finerenone appears superior for cardiorenal protection in CKD and metabolic phenotypes, steroidal MRAs maintain a favorable efficacy-safety balance in heart failure. These hypothesis-generating findings support a phenotype-driven, individualized approach to MRA selection, pending confirmation from prospective clinical trials."

HEOR • Cardiovascular • Congestive Heart Failure • Heart Failure

Renal function and hyperkalemia with first-line eplerenone in obese patients with hypertension: randomized safety data from the HEBRO trial (ESC 2026) - "At 2 and 4 months, stepwise up-titration with amlodipine 5 mg and indapamide 1.5 mg, respectively, was performed if mean ABPM remained >130/80 mmHg. Conclusion In obese hypertensive patients, first-line treatment with eplerenone was not associated with excess renal function decline or clinically significant hyperkalemia compared with irbesartan. These findings support the renal safety of MRA-based first-line therapy in this population."

Clinical • Cardiovascular • Hypertension

Eplerenone vs irbesartan as first line therapy in obese hypertensive patients: results of the HEBRO randomized controlled trial (ESC 2026) - "At 2 months and 4 months up-titration with amlodipine 5mg and indapamide 1.5mg respectively was taken place when mean ambulatory BP (ABPM) was over 130/80mmHg. At 6 months, mean ambulatory BP reduction was -17.5/-9.6 mmHg ± 12.0/6.7 in the irbesartan vs. -19.0/-9.0 mmHg ± 12.6/8.2 in the eplerenone arm, p=0.463 and p=0.611 respectively. At 6 months, the number of antihypertensive drugs was 1.8 ± 0.8 vs 1.9 ± 0.8, p=0.164.ConclusionAt 6 months, eplerenone-based antihypertensive strategy is non-inferior compared to irbesartan-based strategy regarding reducing ABPM, under the same number of antihypertensive medications, accompanied by no difference in safety and renal function preservance."

Clinical • Cardiovascular • Hypertension