Objective  To investigate the clinical comprehensive value of finerenone in the treatment of diabetic nephropathy (DN), and to provide evidence-based medicine evidence for clinical drug decision.

Methods  PubMed, Web of Science, Embase, Cochrane Library, WanFang Data, CNKI and health technology assessment (HTA) official website were systematically searched to collect the systematic review/Meta-analysis and pharmacoeconomic evaluation on finerenone in treatment of DN from the inception to November 31, 2023. The method of rapid HTA was used to evaluate the effectiveness, safety and economic evaluation. The innovation, suitability and accessibility of finerenone were analyzed by relevant data from drug instructions, professional websites such as the National Medical Products Administration (NMPA) and Center for Drug Evaluation, NMPA.

Results  In terms of effectiveness, finerenone significantly reduced the risk of the renal composite events and composite cardiovascular outcomes in DN compared with placebo and traditional mineralocorticoid receptor antagonist (MRA). In terms of safety, the incidence of adverse reactions and acute kidney injury of finerenone was similar to that of placebo and traditional MRA, but the incidence of hyperkalemia was higher than that of placebo. In terms of economy, two foreign HTA reports showed that finerenone was more economical than standard treatment. In terms of innovation, finerenone was the world's first approved non-steroidal, selective MRA innovative drug for the treatment of type 2 DN, making its efficacy and adverse reactions more advantageous. In terms of suitability, finerenone should only be taken once a day, which had good suitability in pharmaceutical properties and clinical use. In terms of accessibility, the domestic price of finerenone was lower than the international price, and it was included in the medical insurance, and the market coverage was high, it had a good affordability and availability.

Conclusion  Finerenone has good effectiveness and safety in the treatment of DN, but attention should be paid to the risk of hyperkalemia, and its economy requires further economic research in China. As the world's first approved non-steroidal, selective MRA innovative drug, finerenone has better innovation, suitability and accessibility.

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