Finerenone–empagliflozin superior to either agent alone in patients with CKD and type 2 diabetes

Patients with chronic kidney disease (CKD) and type 2 diabetes have increased risks of cardiovascular disease and kidney failure. Medical management currently includes the use of renin–angiotensin system blockers, sodium–glucose cotransporter-2 (SGLT2) inhibitors (e.g., empagliflozin), finerenone (a nonsteroidal mineralocorticoid receptor antagonist) and glucagon-like peptide-1 receptor agonists. The goal of these therapies is to reduce the risk of CKD progression and cardiovascular complications.Some evidence suggests that finerenone may have additive effects for reducing the urinary albumin-to-creatinine ratio and related outcomes when added to SGLT2 inhibitor therapy. However, only limited evidence exists to support the simultaneous initiation of an SGLT2 inhibitor and finerenone in patients with chronic kidney disease (CKD) and type 2 diabetes. To investigate this issue, researchers conducted a double-blind, randomized, international multicentre trial. They studied patients with CKD (estimated glomerular filtration rate [eGFR], 30–90 mL per minute per 1.73 m2 body-surface area), albuminuria (a urinary albumin-to-creatinine ratio of 100 to ≤ 5,000) and type 2 diabetes, who were already taking a renin–angiotensin system inhibitor (angiotensin-converting–enzyme inhibitor or angiotensin-receptor blocker). Participants were randomly assigned in a 1:1:1 ratio to receive:finerenone 10 or 20 mg/day (with empagliflozin-matching placebo)empagliflozin 10 mg/day (with finerenone-matching placebo), ora combination of finerenone and empagliflozin. The primary outcome was the relative change in the log-transformed mean urinary albumin-to-creatinine ratio from baseline to 180 days. The safety of simultaneous initiation of these two drugs was also assessed by measuring blood pressure, serum potassium level and eGFR at frequent predefined intervals and by monitoring adverse events.Results showed the following:The study included 800 participants; 269 were assigned to the combination therapy group, 264 to the finerenone group and 267 to the empagliflozin group.At baseline, the urinary albumin-to-creatinine ratio was similar among the participants in the three groups (median value, 579).At day 180, the reduction in the urinary albumin-to-creatinine ratio with combination therapy was 29% greater with finerenone–empagliflozin than with finerenone alone (least-squares mean ratio of the difference in the change from baseline, 0.71; 95% confidence interval [CI], 0.61–0.82; p

Finerenone–empagliflozin superior to either agent alone in patients with CKD and type 2 diabetes

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