Roshni Gat
Shivani Kashid
Abstract
Background: In this work, we provide strong evidence for the safety and efficacy of finerenone in people with type 2 diabetes and chronic kidney disease. Our goal is to improve patients’ quality of life and general well-being through our research. Aim: Finerenone exhibited a significant decrease in the likelihood of renal and cardiovascular (CV) events in individuals with both type 2 diabetes and chronic kidney disease. This exploratory subgroup analysis aims to investigate the potential influence of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on the therapeutic efficacy of finerenone. Material and Method: A systemic review was undertaken, during which we scrutinized 5340 cases of these patients. Result: 394 patients, or 6.9% of the 5340 patients analyzed, were given GLP-1RAs. Finerenone was linked to a decreased UACR regardless of baseline GLP-1RA use, as evidenced by a ratio of least-squares mean of 0.69. Based on the analysis, the hazard ratio for patients who did not take GLP-1RA was 0.67 (95% confidence interval 0.67, 0.72) and for patients who did use GLP-1RA, it was 0.63 (95% confidence interval 0.56, 0.70) (p value for interaction > 0.20). Crucially, at baseline, the p values for interaction (> 0.15 and > 0.51, respectively) show that the presence of GLP-1RA had no discernible effect on the efficacy of finerenone in lowering critical secondary cardiovascular outcomes or primary kidney outcomes (defined as time to kidney failure, sustained decline in estimated glomerular filtration rate ≥40% from baseline compared to the placebo). Conclusion: Finerenone demonstrated significant advantages for both renal and cardiovascular health with minimal adverse effects. In the context of chronic kidney disease linked to type 2 diabetes, finerenone may be considered as a promising therapeutic option.
Keywords: Finerenone, Type 2 Diabetes , Chronic kidney Disease,Glomerular filtration, Cardiovascular outcomes, GLP-1 receptor agonists
[This article belongs to International Journal of Antibiotics(ijab)]
References
Muskiet MH, Wheeler DC, Heerspink HJ. New pharmacological strategies for protecting kidney function in type 2 diabetes. The Lancet Diabetes & Endocrinology. 2019 May 1;7(5):397-412
Sloan LA. Review of glucagon‐like peptide‐1 receptor agonists for the treatment of type 2 diabetes mellitus in patients with chronic kidney disease and their renal effects. Journal of diabetes. 2019 Dec;11(12):938-48.
Thomas MC, Cooper ME, Zimmet P. Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease. Nature Reviews Nephrology. 2016 Feb;12(2):73-81
Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, Hobbs FR. Global prevalence of chronic kidney disease–a systematic review and meta-analysis. PloS one. 2016 Jul 6;11(7):e0158765.
Ingelfinger JR, Rosen CJ. Finerenone – Halting Relative Hyperaldosteronism in Chronic Kidney Disease. N Engl J Med 2020;383:2285-6.
Gilbert KC, Brown NJ. Aldosterone and inflammation. Curr Opin Endocrinol Diabetes Obes2010;17:199-204
Yamazaki T, Mimura I, Tanaka T, Nangaku M: Treatment of diabetic kidney disease: current and future . Diabetes Metab J. 2021, 45:11-26. 10.4093/dmj.2020.0217
Barrera-Chimal J, Lima-Posada I, Bakris GL, Jaisser F: Mineralocorticoid receptor antagonists in diabetic kidney disease – mechanistic and therapeutic effects. Nat Rev Nephrol. 2022, 18:56-70. 10.1038/s41581-021 00490-8
Afkarian M, Sachs MC, Kestenbaum B, et al. Kidney disease and increased mortality risk in type 2 diabetes. J Am Soc Nephrol 2013;24:302–8.
Li H, Lu W, Wang A, et al. Changing epidemiology of chronic kidney Disease as a result of type 2 diabetes mellitus from 1990 to 2017: Estimates from Global Burden of Disease 2017. J Diabetes Investig2021;12:346–56.
Pitt B, Kober L, Ponikowski P, et al. Safety and tolerability of the novelNon-steroidal mineralocorticoid receptor antagonist BAY 94-8862 in Patients with chronic heart failure and mild or moderate chronic kidney disease: a randomized, double-blind trial. Eur Heart J 2013;34:2453–63.
| Volume | 01 |
| Issue | 02 |
| Received | January 12, 2024 |
| Accepted | January 24, 2024 |
| Published | February 1, 2024 |