Finerenone efficacy in patients with chronic kidney disease, type 2 diabetes and atherosclerotic cardiovascular disease

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  • Gerasimos Filippatos
  • Stefan D. Anker
  • Bertram Pitt
  • Darren K. McGuire
  • Rossing, Peter
  • Luis M. Ruilope
  • Javed Butler
  • Ewa A. Jankowska
  • Erin D. Michos
  • Dimitrios Farmakis
  • Alfredo E. Farjat
  • Peter Kolkhof
  • Andrea Scalise
  • Amer Joseph
  • George L. Bakris
  • Rajiv Agarwal

AIMS: Finerenone, a selective, non-steroidal mineralocorticoid receptor antagonist, improves cardiovascular (CV) and kidney outcomes in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). This subgroup analysis of FIDELITY, a pre-specified, pooled, individual patient-data analysis of FIDELIO-DKD (NCT02540993) and FIGARO-DKD (NCT02545049), compared finerenone vs. placebo in patients with and without baseline history of atherosclerotic CV disease (ASCVD). METHODS AND RESULTS: Outcomes included a composite CV outcome [CV death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure (HHF)]; CV death or HHF; a composite kidney outcome (kidney failure, sustained estimated glomerular filtration rate decrease ≥57%, or kidney-related death); all-cause mortality; and safety by baseline history of ASCVD.Of 13 026 patients, 5935 (45.6%) had a history of ASCVD. The incidence of the composite CV outcome, CV death or HHF, and all-cause mortality was higher in patients with ASCVD vs. those without, with no difference between groups in the composite kidney outcome. Finerenone consistently reduced outcomes vs. placebo in patients with and without ASCVD (P-interaction for the composite CV outcome, CV death or HHF, the composite kidney outcome, and all-cause mortality 0.38, 0.68, 0.33, and 0.38, respectively). Investigator-reported treatment-emergent adverse events were consistent between treatment arms across ASCVD subgroups. CONCLUSION: Finerenone reduced the risk of CV and kidney outcomes consistently across the spectrum of CKD in patients with T2D, irrespective of prevalent ASCVD.

Original languageEnglish
JournalEuropean heart journal. Cardiovascular pharmacotherapy
Volume9
Issue number1
Pages (from-to)85-93
Number of pages9
ISSN2055-6837
DOIs
Publication statusPublished - 2023

Bibliographical note

Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

    Research areas

  • Atherosclerotic cardiovascular disease, Chronic kidney disease, Finerenone, Mineralocorticoid receptor antagonist, Type 2 diabetes

ID: 340555186