June 1, 2023

Sodium-glucose cotransporter-2 inhibitors, finerenone can be mixed in CKD, diabetes care – Healio


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Rossing P, et al. Finerenone in patients with CKD and type 2 diabetes by SGLT-2i treatment: The FIDELITY Analysis. Presented at: ASN Kidney Week; Nov. 4-7, 2021 (virtual meeting).

Rossing reports consultancies from Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Gilead, Eli Lily, Mereck, MSD, Mundipharma, Novo Nordisk, Sanofi and Vifor Pharma; and grants from AstraZeneca and Novo Nordisk.

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There was no significant difference in results when giving finerenone with or without sodium-glucose cotransporter-2 inhibitors to patients with type 2 diabetes and chronic kidney disease, according to a speaker at ASN Kidney Week.

“Finerenone is a novel selected nonsteroidal magnetic resonance angiography that inhibits mineralocorticoid receptor overactivation, and that is associated with inflammation and fibrosis, at least in the preclinical models,” Peter Rossing, MD, DMSc, head of complications research and chief physician at Steno Diabetes Center Copenhagen in the department of clinical medicine at the University of Copenhagen, said. “The FIDELITY prespecified pooled analysis showed cardiorenal benefits of finerenone across the spectrum of chronic kidney disease and type 2 diabetes.”

“The aim of this subgroup analysis was to explore the treatment effect of finerenone compared to placebo in those with or without sodium-glucose cotransporter-2 inhibitors (SGLT-2i) at baseline,” he said.

In the FIDELIO-DKD and FIGARO-DKD phase 3 trials, all patients were treated with optimized renin–angiotensin system blockade before being randomized to either finerenone or placebo.

Patients treated with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) at baseline experienced a higher mean eGFR (66 mL/min/1.73 m2 vs. 57 mL/min/1.73 m2) lower urine albumin-creatine ratio (448 mg/g vs. 521 mg/g) and higher statin (84% vs. 71%) and glucagon-like peptide-1 receptor agonist use (19% vs. 6%) than patients who did not have SGLT-2i treatment at baseline.

“Whether you are treated with an SGLT-2i or not, we found consistent kidney and cardiovascular benefits of finerenone compared to placebo, and also we found benefits of albuminuria which was similar with or without SGLT-2i at baseline,” Rossing said. “Safety outcomes were also consistent irrespective of SGLT-2i use at baseline, but further studies are required to clarify any additional clinical benefits with combined finerenone and SGLT-2i therapies in this patient population.”

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Source: https://www.healio.com/news/nephrology/20211110/sodiumglucose-cotransporter2-inhibitors-finerenone-can-be-mixed-in-ckd-diabetes-care