Finerenone lowers Cv and kidney risks in Type 2 diabetes with CKD: Study

In order to investigate whether compliance with guidelines prior to initiation of finerenone impacts its efficacy, FIDELITY database was used that consisted of a large prospective, prespecified pooled analysis including participant-level data from two double-blinded multicenter studies FIDELIO-DKD (NCT02540993) and FIGARO-DKD (NCT02545049). Study subjects were adult patients with type 2 diabetes mellitus and chronic kidney disease and had been assigned to oral treatment with finerenone or placebo in the proportion of 1:1.

At the initial stage of the study, all study subjects were classified into different subgroups depending on the specific number of standard ADA therapeutic goals met by the subject before inclusion (0, 1, 2, or 3 or more goals). The following endpoints were assessed among these groups: composite cardiovascular outcome, composite kidney outcome, heart failure or cardiovascular mortality, heart failure hospitalization only, and treatment-emergent adverse events.

Key findings:

• Among the combined population of participants, 29.0% achieved 0 treatment goals, 40.0% had 1 goal achieved, 24.0% were able to achieve 2 goals, and just 7.0% met 3 or more goals prior to study initiation.
• In the placebo arm, participants having achieved fewer number of baseline goals experienced a significantly increasing incidence rate of cardiovascular composite events in proportions of 6.0, 5.1, 4.3, and 3.5 events per 100 patient-years in the achievement of 0, 1, 2, and 3+ goals, respectively.
• Any statistical heterogeneity in terms of the treatment difference between finerenone and placebo was found to be entirely absent in relation to the relative effect of treatment on cardiorenal endpoints.
• There was no variation in either of the safety or tolerability profiles of finerenone compared to the placebo group, which also showed no variability among the proportions of treatment-emergent adverse events.

Overall, this comprehensive exploratory analysis shows that finerenone can be considered a valuable drug that contributes significantly to the survival of patients suffering from chronic kidney disease and type 2 diabetes. It can improve their heart and kidney function no matter how many treatment goals set by the ADA a patient has met before starting the therapy. The results presented here are critical for medicine practice because they give clinicians confidence that patients should not have ideal metabolic and hemodynamic parameters before introducing finerenone to their regimen.

Reference:

J. S.Neves, A. R.Leite, F.Vasques-Nóvoa, et al., “Outcomes With Finerenone by Baseline Treatment Goals in Type 2 Diabetes and Chronic Kidney Disease: A FIDELITY Analysis,” Diabetes, Obesity and Metabolism (2026): 1–12, https://doi.org/10.1111/dom.70750.