A FIDELITY Analysis on Finerenone With SGLT-2i and GLP-1RA in CKD

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Finerenone offers kidney and cardiovascular benefits in type 2 diabetes (T2D) and chronic kidney disease (CKD) patients on renin-angiotensin system (RAS) inhibition.
• Combination therapies are increasingly recommended for managing CKD and T2D.

Purpose of the Study:

• To assess the efficacy and safety of finerenone versus placebo in CKD and T2D patients using concomitant sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and/or glucagon-like peptide-1 receptor agonists (GLP-1RA).

Main Methods:

• A subanalysis of the FIDELITY trial examined changes in urine albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and systolic blood pressure (SBP).
• Adverse events were analyzed across subgroups based on baseline concomitant medication: combined SGLT-2i and GLP-1RA, neither, SGLT-2i only, and GLP-1RA only.

Main Results:

• Finerenone significantly reduced UACR and SBP compared to placebo across all subgroups.
• The greatest UACR reduction was observed in the finerenone subgroup receiving both SGLT-2i and GLP-1RA.
• Finerenone slowed eGFR decline, and its safety profile was unaffected by concomitant SGLT-2i/GLP-1RA use, with low rates of hyperkalemia.

Conclusions:

• Concomitant use of finerenone with SGLT-2i and/or GLP-1RA shows potential synergistic effects in preserving kidney function and lowering blood pressure in CKD and T2D patients.
• The combination therapy demonstrated a favorable safety profile, suggesting it as a viable treatment strategy.