Treatment Patterns, Adverse Events, and Clinical Outcomes with Steroidal Mineralocorticoid Receptor Antagonists: A Retrospective Analysis of Administrative Claims Data (RELICS).

Purpose: This study aimed to describe the characteristics, treatment patterns, adverse events (AEs), and clinical outcomes of patients starting steroidal mineralocorticoid receptor antagonists (sMRAs) in real-world settings. Methods: The RELICS study, complementing the survey-based RELICS-PS study, was a retrospective cohort study conducted using the Healthcare Integrated Research Database (HIRD Results: Of the 224,100 sMRA initiators identified, 76.4% did not have documented HF or CKD (ie, "all other patients" subgroup). This subgroup was younger and primarily female. Across all initiators, 72.3% were nonadherent, and 73.0% discontinued treatment within a median of 90 days of initiation. Of these discontinuers, 44.2% restarted treatment within a median of 91 days of discontinuation. Factors decreasing odds of discontinuation across most subgroups included a higher comorbidity burden, use of other cardiovascular medications, and cardiologist prescribing. These findings were consistent across subgroups. AEs and clinical outcomes varied across subgroups in line with baseline comorbidity profiles. Patients with a higher comorbidity burden, such as those with both CKD and T2D rather than CKD alone, experienced worse outcomes. Conclusion: High rates of treatment discontinuation and subsequent restart were observed across all subgroups, implying fluctuating sMRA use. However, heightened cardiovascular risk may decrease the odds of discontinuation.