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A “New Star” In The Treatment Of Diabetic Nephropathy — Lucifine Finerenone

LUCIFINE finerenone tablets

Diabetic kidney disease (DKD) refers to chronic kidney disease (CKD) caused by diabetes, and the pathology can involve the entire kidney, including the glomeruli, renal tubules, renal interstitium, and renal blood vessels. The main characteristics include a urinary albumin-to-creatinine ratio (UACR) ≥30mg/g and/or an estimated glomerular filtration rate (eGFR) <60mL/min/1.73 m2, persisting for more than 3 months. Eventually, it can progress to end-stage renal disease (ESRD). Approximately 30% to 50% of global ESRD cases are attributed to DKD, making it the leading cause of ESRD in elderly people worldwide. DKD patients experience a significant increase in cardiovascular risk and overall mortality risk as kidney disease progresses.

Symptoms Of Diabetic Kidney Disease Include

Edema: Edema is a primary manifestation in patients with diabetic kidney disease. In the early stages, most patients do not experience edema. However, some may develop mild edema when plasma protein levels decrease. Significant edema usually appears when 24-hour urine protein exceeds 3 grams.

Proteinuria: Proteinuria is an early sign of diabetic kidney disease. It initially presents as trace amounts of protein in the urine, and it may be intermittent at first but gradually becomes persistent. The presence of proteinuria can predict the progression of diabetic kidney disease.

High Blood Pressure: Almost all cases of diabetic kidney disease are accompanied by high blood pressure. Blood pressure control is closely related to the development of diabetic kidney disease, as hypertension can exacerbate kidney disease, and the two conditions can mutually influence each other.

Anemia: As diabetic kidney disease progresses to renal insufficiency, it can lead to a reduction in the secretion of erythropoietin, resulting in anemia.

Nocturia: Increased nighttime urination is an early symptom of diabetic kidney disease. This occurs because the afferent arterioles of the smallest units of the kidneys, the glomeruli, dilate, while the efferent arterioles, relatively narrowed due to sclerosis, cause an increase in renal blood perfusion pressure. Especially when lying flat at night, renal blood flow increases, leading to the excretion of excess water from the glomeruli. This exceeds the reabsorption capacity of the renal tubules, resulting in increased nighttime urination.

Common treatment approaches for DKD

Currently, the prevention and treatment of type 2 diabetes kidney disease (T2DKD) primarily focus on strict control of blood glucose and blood pressure. Widely accepted medications with renal protective effects include renin-angiotensin-aldosterone system (RAAS) inhibitors such as ACE inhibitors (ACEI) or angiotensin II receptor blockers (ARB), as well as novel antidiabetic agents like SGLT-2 inhibitors and GLP-1 receptor agonists. However, for diabetic patients without hypertension, normal urinary albumin-to-creatinine ratio (UACR), and normal estimated glomerular filtration rate (eGFR), ACE inhibitors/ARBs may not delay kidney disease progression and could potentially increase cardiovascular risk. Therefore, the use of ACE inhibitors/ARBs for DKD prevention is not recommended in this specific group. Additionally, even with the mentioned treatment approaches, there remains a risk of disease progression in T2DKD, emphasizing the urgent need to explore new therapeutic drugs.

New Treatment Option for DKD – Lucifine Finerenone

Finerenone is a non-steroidal, selective mineralocorticoid receptor antagonist (MRA) and the first MRA approved globally for the treatment of type 2 diabetes kidney disease (T2DKD). It received approval in the United States (July 2021), the European Union (February 2022), Japan (February 2022), and China (June 2022). This medication is indicated for adult patients with chronic kidney disease associated with type 2 diabetes (eGFR ≥25 to <75 mL/min/1.73 m2, with albuminuria). It has the potential to reduce the risk of sustained eGFR decline and end-stage kidney disease.

LUCIFINE finerenone tablets
LUCIFINE finerenone tablets

Difference between traditional MRAs and a new generation MRA

Mineralocorticoid receptors (MR) are expressed in the kidneys, heart, and blood vessels. Excessive MR activation can mediate inflammation and fibrosis, leading to damage in organs such as the cardiovascular and renal systems.

Traditional MRAs: Steroidal MRAs such as spironolactone and eplerenone are primarily used to treat hypertension and improve the prognosis of heart failure. However, they come with issues such as hormone-related adverse reactions (e.g., gynecomastia in males) and lower binding efficacy to MR.

New-generation MRA: Non-steroidal MRA, exemplified by finerenone, acts as a potent antagonist to MR. It can block MR-mediated sodium reabsorption and excessive MR activation, thereby improving damage to target organs. Importantly, it exhibits high selectivity for MR, with very low affinity for androgen, progesterone, estrogen, and glucocorticoid receptors. As a result, it avoids hormone-related adverse reactions, making it a safer option.

How to take Lucifine finerenone correctly

1.Pre-Initiation Assessment

Measure blood potassium levels and eGFR before initiating finerenone treatment.

Do not recommend starting finerenone treatment if blood potassium is >5 mmol/L or eGFR is <25 mL/min/1.73 m2.

2.Initiating Treatment for Eligible Patients

For patients meeting the initiation criteria, choose the starting dose based on eGFR levels, as outlined in Table 1.

Table 1: Recommended Starting Doses for Finerenone

eGFR(mL/min/173m2)Starting Dose
≥6020 mg once daily
≥25t0<6010 mg once daily
<25Initiation is not recommended
Note: For patients who are unable to swallow the whole tablet, finerenone tablets can be crushed before administration. The crushed tablet can be mixed with water or soft food (such as applesauce) and taken orally immediately.

3.Close Monitoring of Blood Potassium and eGFR Levels During Treatment

The target dose for finerenone is 20 mg, once daily.

Within the first 4 weeks of starting treatment, assess blood potassium levels and adjust the dosage accordingly.

Monitor blood potassium levels within 4 weeks after each dosage adjustment and throughout the entiretreatment period. Adjust the dosage as needed, referring to Table 2.

Table 2: Dose Adjustment Based on Current Blood Potassium Level and Current Finerenone Dose

Current LUCIFINE Dose
 10 mg once daily20 mg once daily
CurrentSerumPotassium(mEq/L)≤4.8Increase the dose to20 mg once daily.*Maintain 20 mg oncedaily.
 CurrentSerumPotassium(mEq/L)>4.8-5.5Maintain 10 mg oncedaily.Maintain 20 mg oncedaily.
 CurrentSerumPotassium(mEq/L)>5.5Withhold LUCIFINEConsider restartingat 10 mg once dailywhen serumpotassium≤5.0mEq/L.Withhold LUCIFINERestart at 10 mgonce daily whenserumpotassium<5.0 mEq/L

If eGFR decreases by more than 30% compared to the last assessment, maintain the 10 mg dose.

4.Missed Dose

Patients who discover a missed dose should take it as soon as possible on the same day. If a dose is missed on a day, do not double the dose. Instead, skip the missed dose and continue with the next scheduled dose according to the prescription.

5.Special Populations: How to Use Finerenone

For guidance on how special populations should use finerenone, refer to Table 3.

Table 3: Recommendations for the Use of Finerenone in Special Populations

Special groupsFinerenone medication recommendations
Patients with hepatic insufficiencyAdditional serum potassium monitoring should be considered in patients with moderate hepatic impairment and monitoring should be adjusted based on the patient’s condition
Not recommended for patients with severe hepatic impairment
Pregnant or breastfeeding womenThere is no relevant data yet and its use is not recommended.
Children and teenagers under 18 years oldThere is no relevant data yet and its use is not recommended.
Elderly patientsNo dosage adjustment required

6.Precautions for Finerenone Use

Refer to Table 4 for important considerations and recommendations regarding the use of finerenone.

Table 4: Precautions and Recommendations for Finerenone Use.

Precautions and suggestions for taking FinerenoneSuggestions
HyperkalemiaMost commonly during Finerenone therapy
See adverse reactions as hyperkalemia
1.Serum potassium levels should be remonitored 4 weeks after initiating, adjusting dose, or restarting treatment
2.Certain patients are at a higher risk of developing hyperkalemia. Risk factors include low eGFR levels, high blood potassium levels, and previous episodes of hyperkalemia. The above patients should monitor their blood potassium more frequently during medication and may have elevated blood potassium levels. The risk of hyperkalemia will increase when potassium-containing drugs are used together, so medication should be used with caution
Renal impairmentThe risk of hyperkalemia increases with renal
function decreases and increases
Renal function should be remonitored 4 weeks after initiation, dose adjustment, or restart of treatment
Excipient informationFenelidone prescriptions contain lactosePatients with rare hereditary galactose intolerance, lactase deficiency, or glucose-galactose malabsorption should not use fenelidone

7.Recommendations for Drug Combinations with Finerenone

Refer to Table 5 for considerations and recommendations regarding the concurrent use of finerenone with other medications.

Table 5: Recommendations for Drug Combinations with Finerenone

Recommendations for use with FinerenoneCombination drug categoriesExamplerisk of combined use
Joint use prohibitedStrong inhibitor of CYP3A4Itraconazole, clarithromycin, ketoconazole, etc.Coadministration may significantly increase Finerenone exposure
 Strong and moderate inducers of CYP3A4Rifampicin, carbamazepine, phenobarbital, etc.Coadministration may significantly reduce Finerenone exposure
Not recommended for combined useDrugs that raise blood potassiumPotassium-sparing diuretics (amiloride, triamterene, etc.)Concomitant use increases the risk of hyperkalemia
  Other MRAs (spironolactone, eplerenone, etc.) 
  Potassium supplements, trimethoprim or trimethoprim/sulfamethoxazole 
Use caution in combinationModerate and weak inhibitors of CYP3A4Erythromycin, verapamil, etc.Coadministration may increase Finerenone exposure
   It is recommended that the dose of Finerenone be adjusted as appropriate
 antihypertensive drugsLosartan, perindopril, etc.Concomitant use of multiple other antihypertensive drugs may increase
   Risk of hypotension, blood pressure monitoring recommended

Note: Grapefruit juice can also inhibit the CYP3A4 enzyme. Therefore, during finerenone treatment, consumption of grapefruit or grapefruit juice should be avoided.

Pharmacist’s Advice

Finerenone is the world’s first non-steroidal MRA approved for the treatment of type 2 diabetes-related chronic kidney disease. It provides a new option for the treatment of diabetic kidney disease. Given the relatively short time since the approval of finerenone, it is anticipated that future clinical experiences and research evidence will contribute to further benefits for patients with diabetic kidney disease.

In addition to medication, comprehensive management is recommended for diabetic kidney disease patients to reduce adverse renal events and the risk of death. This includes:

Lifestyle adjustments: This involves reasonable weight control, diabetes-friendly diet, improved nutrition, smoking cessation, and appropriate exercise.

Control of risk factors: Manage blood sugar, blood pressure, blood lipids, uric acid levels, etc.

Enhanced patient education: Continuously raise patient awareness of health and improve treatment compliance.

A holistic approach, combining medication with lifestyle adjustments and effective control of risk factors, is crucial for optimizing the management of diabetic kidney disease and improving patient outcomes.

How to Find Affordable LUCIFINE Finerenone Tablets

It’s widely known that the treatment for type 2 diabetes, RYBELSUS® (semaglutide) tablets, comes with a high cost of up to $995 for 30 tablets. Similarly, the medication for treating diabetic kidney disease, Kerendia finerenone tablets, can be as expensive as $670 for 30 tablets. The exorbitant prices of these medications undoubtedly add to the challenges faced by patients in their daily lives.

Is there an equally effective but more affordable medication available? The answer is LUCIFINE finerenone tablets produced by Lucius Pharmaceuticals. LUCIFINE finerenone tablets are a diabetes kidney disease treatment that has received approval from the Laotian Ministry of Health and is manufactured in Lucius Pharmaceuticals’ GMP factory in Laos, as approved by the U.S. FDA.

LUCIFINE finerenone tablets are not only a legitimately authorized medication but also come at a very affordable price, being only one-third the cost of Kerendia finerenone tablets while delivering the same efficacy.

DKD Care Center serves as the authoritative global distributor for LUCIFINE finerenone tablets, and we possess the necessary authorization certificates from Lucius Pharmaceuticals. The introduction of this new medication comes with significant discounts. If you have been suffering from diabetic kidney disease for an extended period, please don’t hesitate to contact us promptly:

Phone: +852 6993858

Whatsapp: +856 9506 4225



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