Finerenone in patients across the spectrum of chronic kidney disease and type 2 diabetes by glucagon-like peptide-1 receptor agonist use.
Peter Rossing, Rajiv Agarwal, Stefan D Anker, Gerasimos Filippatos, Bertram Pitt, Luis M Ruilope, Vivian Fonseca, Guillermo E Umpierrez, Maria Luiza Caramori, Amer Joseph, Marc Lambelet, Robert Lawatscheck, George L Bakris, FIDELIO-DKD and FIGARO-DKD Investigators
Author Information
Peter Rossing: Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark. ORCID
Rajiv Agarwal: Richard L. Roudebush VA Medical Center and Indiana University School of Medicine, Indianapolis, Indiana, USA. ORCID
Stefan D Anker: Department of Cardiology (CVK); Berlin Institute of Health Center for Regenerative Therapies; German Centre for Cardiovascular Research partner site Berlin, Charité - Universitätsmedizin, Berlin, Germany.
Gerasimos Filippatos: National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece.
Bertram Pitt: Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
Luis M Ruilope: Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research imas12, Madrid, Spain.
Vivian Fonseca: Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA. ORCID
Guillermo E Umpierrez: Division of Endocrinology, Emory University, Atlanta, Georgia, USA. ORCID
Maria Luiza Caramori: Department of Medicine and Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.
AIMS: To explore the modifying effect of glucagon-like peptide-1 receptor agonist (GLP-1RA) use on outcomes with Finerenone across a wide spectrum of patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the pooled analysis of FIDELIO-DKD and FIGARO-DKD. MATERIALS AND METHODS: patients with T2D and CKD treated with optimized renin-angiotensin system blockade were randomized to Finerenone or placebo. Effects of Finerenone on a cardiovascular composite outcome (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure) and a kidney composite outcome (kidney failure, sustained ≥57% estimated glomerular filtration rate [eGFR] decline, or renal death), change in urine albumin-to-creatinine ratio (UACR), and safety were analysed by GLP-1RA use. RESULTS: Of 13 026 patients, 944 (7.2%) used GLP-1RAs at baseline. Finerenone reduced the risk of the cardiovascular composite outcome (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.52-1.11 with GLP-1RA; HR 0.87, 95% CI 0.79-0.96 without GLP-1RA; P-interaction = 0.63) and the kidney composite outcome (HR 0.82, 95% CI 0.45-1.48 with GLP-1RA; HR 0.77, 95% CI 0.67-0.89 without GLP-1RA; P-interaction = 0.79) irrespective of baseline GLP-1RA use. Reduction in UACR with Finerenone at Month 4 was -38% in patients with baseline GLP-1RA use compared with -31% in those without GLP-1RA use (P-interaction = 0.03). Overall safety and incidence of hyperkalaemia were similar, irrespective of GLP-1RA use. CONCLUSIONS: The cardiorenal benefits of Finerenone on composite cardiovascular and kidney outcomes and UACR reduction in patients with CKD and T2D appear to be maintained, regardless of GLP-1RA use. Subsequent studies are needed to investigate any potential benefit of this combination.
