Finerenone in patients across the spectrum of chronic kidney disease and type 2 diabetes by glucagon-like peptide-1 receptor agonist use

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 cardiovascular (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure) and kidney (kidney failure, sustained ≥57% eGFR decline, or renal death) composite outcomes, change in UACR, and safety were analyzed by GLP-1RA use.

RESULTS: Of 13,026 patients, 944 (7.2%) used GLP-1RAs at baseline. Finerenone reduced the risk of the cardiovascular (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 kidney (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) composite outcomes 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 hyperkalemia 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. This article is protected by copyright. All rights reserved.