Real-World Utilisation and Cost Trends of Mineralocorticoid Receptor Antagonists in England: A Population-Level Prescribing Analysis From 2022 to 2025

Background: Mineralocorticoid receptor antagonists (MRAs) are a cornerstone in the management of cardiovascular and renal diseases. However, the introduction of newer agents and changes in drug pricing may influence prescribing patterns and healthcare expenditure. Objective: We aimed to evaluate temporal trends in utilisation, cost and cost per item of MRAs in England. Methods: A retrospective observational study was conducted using publicly available prescribing data from OpenPrescribing, which reports NHS primary care prescribing in England for prescriptions dispensed in the community. Annual data from 2022 to 2025 were analysed for spironolactone, eplerenone and finerenone. Outcomes included total items dispensed, items per 100,000 population, total Actual Cost (£) and cost per item. Results: Spironolactone remained the most frequently dispensed MRA, with utilisation increasing from 3,140,245 items (5491 per 100,000 population) in 2022 to 4,060,648 (6902 per 100,000) in 2025. Eplerenone utilisation increased from 1,180,762 items (2065 per 100,000) to 1,963,447 (3337 per 100,000). Finerenone demonstrated rapid uptake following minimal initial use, reaching 35,484 items (60.3 per 100,000) in 2025. Total costs for spironolactone increased over the study period, whereas eplerenone costs declined in 2025 despite increased utilisation. Finerenone costs rose in parallel with uptake. Cost per item was lowest for spironolactone from 2022 to 2024, but eplerenone was lower in 2025 (£2.22 vs. £3.13); finerenone remained highest. Conclusion: 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.