Finerenone reduces the risk of cardiovascular and kidney outcomes in patients with type 2 diabetes and chronic kidney disease
Presenter: Ajay K. Singh, MD, Harvard Medical School, Boston, Massachusetts.
Concomitant use of finerenone with an SGLT-2 inhibitor plus GLP-1RA may provide additional kidney benefits in patients with diabetes and chronic kidney disease.
Adding finerenone to baseline therapy with a sodium-glucose cotransporter 2 (SGLT-2) inhibitor plus a glucagon-like peptide-1 receptor agonist (GLP-1RA) may provide further benefit in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD), according to results of the FIDELITY trial presented by Ajay K. Singh, MD, Harvard Medical School, Boston, MA, in a Kidney Week 2024 oral presentation.
In the FIDELITY trial, a prespecified pooled analysis of the FIDELIO-DKD and FIGARO-DKD trials, finerenone significantly reduced the risk of cardiovascular and kidney outcomes in patients with CKD (albuminuria and estimated glomerular filtration rate [eGFR] ≥ 25-90 mL/min/1.73 m2) and T2D. Finerenone is a novel, selective, nonsteroidal mineralocorticoid receptor antagonist approved for use in adults with CKD associated with type 2 diabetes.
Using FIDELITY data, investigators explored the treatment effect of finerenone in 167 patients (of 12,990 patients) using concomitant therapy with SGLT-2 inhibitor plus GLP-1RA at baseline. The data included T2D patients receiving optimized renin-angiotensin system inhibition. They had been randomized 1:1 to finerenone or placebo.
Dr. Singh reported that the addition of finerenone led to a greater reduction in urine albumin-to-creatinine ratio (UACR) from baseline to month 4 versus placebo (finerenone mean 0.613 [range 0.493-0.762]; placebo mean 0.987 [range 0.819-1.190]; P = .0012). At month 12, the UACR reduction was 49%, 45%, 35%, and 40% with concomitant use of finerenone with SGLT-2 inhibitor plus GLP-1RA, GLP-1RA alone, SGLT-2 inhibitor alone, and finerenone alone, respectively.
Dr. Singh noted that concomitant use of SGLT2 inhibitor with or without GLP-1RA therapy did not change the finerenone safety profile and that the risk overall of hyperkalemia-related treatment discontinuation or hospitalization was low. Also, a serum potassium level greater than 5.5 to 6 mmol/L was less common in the finerenone plus SGLT-2 inhibitor and GLP-1RA groups than in the finerenone alone group.
Dr. Singh concluded, “In FIDELITY, concomitant use of finerenone with SGLT-2 inhibitor plus GLP-1RA at baseline may have additive kidney benefits versus placebo in patients with T2D and CKD.”
Funding
- Commercial Support – Bayer AG