Finerenone beneficial for CV, and kidney outcomes irrespective of GLP-1 RA use: ADA
Chicago, IL: The use of glucagon-like peptide-1 receptor agonist (GLP-1 RA) does not modify the benefits of finerenone on composite cardiovascular (CV) and kidney outcomes in patients with type 2 diabetes and chronic kidney disease (CKD), says a recent study.
The researchers observed an increased effect for urine albumin-to-creatinine ratio (UACR) reduction indicating a different mechanism of albuminuria reduction. The findings of the study were presented at the 2022 American Diabetes Association Annual Meeting in New Orleans, Louisiana, and subsequently published in the journal Diabetes.
In the FIDELIO-DKD and FIGARO-DKD studies, finerenone was shown to reduce the risk of cardiorenal outcomes in patients with CKD and T2D. In FIDELIO-DKD, the effects of finerenone on kidney and CV outcomes were consistent regardless of GLP-1RA use, but analyses were better powered for evaluating the changes in UACR.
Peter Rossing and colleagues extended these analyses to patients in both studies FIDELITY analysis), thus encompassing a larger population with broader inclusion criteria.
The study included patients with T2D and CKD (UACR ≥30-<300 mg/g and eGFR ≥25-≤90 mL/min/1.73 m2, or UACR ≥300-≤5000 mg/g and eGFR ≥25 mL/min/1.73 m2) treated with optimized renin-angiotensin system blockade. They were randomized to either finerenone or placebo.
The effects of finerenone on CV (nonfatal myocardial infarction, CV death, hospitalization for heart failure, or, nonfatal stroke) and kidney (sustained ≥57% eGFR decline, kidney failure, or renal death) composite outcomes, and UACR at month 4, were analyzed by GLP-1RA use.
Based on the study, the researchers reported the following:
- Of 13026 patients, 944 (7.2%) received GLP-1RAs at baseline.
- Results were consistent irrespective of GLP-1RA use at baseline for the CV composite outcome (hazard ratio [HR] 0.76 with GLP-1RA; HR 0.87 without GLP-1RA), and the kidney composite outcome (HR 0.82 with GLP-1RA; HR 0.77 without GLP-1RA).
- A greater reduction in UACR was observed with finerenone in patients taking GLP-1RA at baseline (placebo-corrected change -38% with GLP-1RA and -31% without GLP-1RA use).
- Incidence of hyperkalemia was similarly increased with finerenone irrespective of GLP-1RA use at baseline.
"The benefits of finerenone on composite CV and kidney outcomes in patients with CKD and T2D are not modified by the use of GLP-1RA at baseline, with an increased effect observed for UACR reduction, indicating a different mechanism of reduction in albuminuria," the authors conclude.
Reference:
PETER ROSSING, STEFAN ANKER, GERASIMOS FILIPPATOS, BERTRAM PITT, LUIS M. RUILOPE, VIVIAN FONSECA, GUILLERMO E. UMPIERREZ, LUIZA CARAMORI, MARC LAMBELET, PRABHAKAR VISWANATHAN, ROBERT LAWATSCHECK, AMER JOSEPH, GEORGE BAKRIS; 22-OR: Finerenone in Patients across the Spectrum of CKD and T2D by GLP-1RA Use. Diabetes 1 June 2022; 71 (Supplement_1): 22–OR. https://doi.org/10.2337/db22-22-OR
