Finerenone in patients across the spectrum of chronic kidney disease and type 2 diabetes by glucagon-like peptide-1 receptor agonist use

• Type of Material: Article
• Authors: Peter Rossing, Steno Diabetes Center Copenhagen, Herlev Denmark; Rajiv Agarwal, Richard L. Roudebush VA Medical Center and Indiana University School of Medicine, Indianapolis Indiana; Stefan D Anker, Charité – Universitätsmedizin, Berlin Germany; Gerasimos Filippatos, Attikon University Hospital, Athens Greece; Bertram Pitt, University of Michigan; Luis M Ruilope, Institute of Research imas12, Madrid Spain; Vivian Fonseca, Tulane University; Guillermo Umpierrez, Emory University; Maria Luiza Caramori, University of Minnesota, Minneapolis; Amer Joseph, Bayer AG; Marc Lambelet, Chrestos Concept GmbH & Co. KG, Essen Germany; Robert Lawatscheck, Bayer AG; George L Bakris, University of Chicago Medicine
• Language: English
• Date: 2022-11-02
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1111/dom.14883
• Title of Journal or Parent Work: DIABETES OBESITY & METABOLISM
• Volume: 25
• Issue: 2
• Start Page: 407
• End Page: 416
• Keywords: Life Sciences & Biomedicine; Endocrinology & Metabolism; Science & Technology; OUTCOMES; SEMAGLUTIDE; SAFETY; CARDIOVASCULAR EVENTS
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Aims: To explore the modifying effect of glucagon-like peptide-1 receptor agonist (GLP-1RA) use on outcomes with finerenone across a wide spectrum of patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the pooled analysis of FIDELIO-DKD and FIGARO-DKD. Materials and methods: Patients with T2D and CKD treated with optimized renin-angiotensin system blockade were randomized to finerenone or placebo. Effects of finerenone on a cardiovascular composite outcome (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure) and a kidney composite outcome (kidney failure, sustained ≥57% estimated glomerular filtration rate [eGFR] decline, or renal death), change in urine albumin-to-creatinine ratio (UACR), and safety were analysed by GLP-1RA use. Results: Of 13 026 patients, 944 (7.2%) used GLP-1RAs at baseline. Finerenone reduced the risk of the cardiovascular composite outcome (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.52–1.11 with GLP-1RA; HR 0.87, 95% CI 0.79–0.96 without GLP-1RA; P-interaction = 0.63) and the kidney composite outcome (HR 0.82, 95% CI 0.45–1.48 with GLP-1RA; HR 0.77, 95% CI 0.67–0.89 without GLP-1RA; P-interaction = 0.79) irrespective of baseline GLP-1RA use. Reduction in UACR with finerenone at Month 4 was –38% in patients with baseline GLP-1RA use compared with –31% in those without GLP-1RA use (P-interaction = 0.03). Overall safety and incidence of hyperkalaemia were similar, irrespective of GLP-1RA use. Conclusions: The cardiorenal benefits of finerenone on composite cardiovascular and kidney outcomes and UACR reduction in patients with CKD and T2D appear to be maintained, regardless of GLP-1RA use. Subsequent studies are needed to investigate any potential benefit of this combination.