SGLT-2 inhibitors and MRAs combo reduces cardiovascular events in patients with CKD

A new study published in Diabetes Research and Clinical Practice suggests that combination of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and mineralocorticoid receptor antagonists (MRAs) may reduce cardiovascular (CV) events more than either SGLT-2 inhibitors or MRAs alone.

Renin-angiotensin-aldosterone system (RAAS) inhibitors and mineralocorticoid receptor antagonists are the pillars of disease-modifying therapy in patients with CKD or systolic heart failure to reduce renal disease progression and heart failure hospitalizations. Independent of diabetes status, sodium-glucose cotransporter 2 (SGLT2) inhibitors prolong life in patients with CKD or systolic heart failure and lower the risk of cardiovascular events and renal disease progression. Mineralocorticoid receptor antagonists and sodium-glucose cotransporter-2 inhibitors have both been found to minimize cardiovascular events in people with type 2 diabetes (T2D) and chronic kidney disease (CKD). However, there is little data to support the advantages of their combined usage. As a result, this study was conducted by Shunichiro Tsukamoto and team with the purpose to see how combination treatment with sodium-glucose cotransporter-2 inhibitors and mineralocorticoid receptor antagonists affected cardiovascular and renal outcomes in type 2 diabetes patients.

Researchers conducted systematic searches in the MEDLINE, PubMed, EMBASE, and Cochrane Library databases until July 2022. In individuals with T2D and CKD, randomized controlled studies comparing SGLT-2 inhibitors, MRAs, or SGLT-2 inhibitor + MRA combination treatment with placebo were chosen. To compare the therapies indirectly, a network meta-analysis was used. A composite of CV events was the primary outcome.

The key findings of this study were:

1. Eight trials with a total of 36,186 patients were chosen.

2. When compared to the other groups, the combination treatment group had a considerably better main result.

3. Furthermore, the combination treatment was linked to a significant reduction in the risk of hyperkalemia.

In conclusion, from the results of this study it is clearly seen that this combination might be a promising therapy option for people with T2D and CKD.

Reference:

Tsukamoto, S., Morita, R., Yamada, T., Urate, S., Azushima, K., Uneda, K., Kobayashi, R., Kanaoka, T., Wakui, H., & Tamura, K. (2022). Cardiovascular and kidney outcomes of combination therapy with sodium-glucose cotransporter-2 inhibitors and mineralocorticoid receptor antagonists in patients with type 2 diabetes and chronic kidney disease: a systematic review and network meta-analysis. In Diabetes Research and Clinical Practice (p. 110161). Elsevier BV. https://doi.org/10.1016/j.diabres.2022.110161