Key takeaways:
- Concurrent use of finerenone and empagliflozin diminished urine albumin-to-creatinine ratio for adults with CKD and kind 2 diabetes.
- Albuminuria discount was higher than for both agent used individually.
Adults with persistent kidney illness and kind 2 diabetes had slower kidney operate decline with a mix of the nonsteroidal mineralocorticoid receptor antagonist finerenone and empagliflozin vs. both alone, in line with examine information.
As well as, researchers noticed no clinically important elevated dangers for hostile occasions with the mix remedy. Information from the CONFIDENCE trial have been offered on the ERA Congress in Vienna and concurrently printed in The New England Journal of Medication.
“Simultaneous initiation of finerenone and an SGLT2 inhibitor supplies early and additive results on urine albumin-to-creatinine ratio discount which can be statistically and
clinically important,” Hiddo J. L. Heerspink, PhD, professor and medical pharmacologist within the division of medical pharmacy and pharmacology on the College Medical Heart Groningen within the Netherlands, informed Healio. “[The combination] is protected, and drug discontinuation as a consequence of hypotension, acute kidney harm and hyperkalemia was unusual.”
Hiddo J. L. Heerspink
For the double-blind randomized, active-controlled trial, Heerspink and colleagues assigned adults with CKD (imply eGFR, 54.2 mL/min/1.73 m2; median urinary albumin-to-creatinine ratio [UARC], 579 mg/g) and kind 2 diabetes to finerenone (Kerendia, Bayer) 10 mg or 20 mg per day plus placebo (n = 264), empagliflozin (Jardiance, Boehringer Ingelheim) 10 mg per day plus placebo (n = 267) or finerenone plus empagliflozin (n = 269) for 180 days after randomization, from June 23, 2022, to March 14, 2025. Individuals continued taking their background renin-angiotensin system inhibitor.
At 180 days, the mix remedy group had a 29% higher discount in UACR from baseline than the finerenone group (least-squares imply ratio of distinction in change from baseline = 0.71; 95% CI, 0.61-0.82) and a 32% higher discount than the empagliflozin group (least-squares imply ratio of distinction in change from baseline = 0.68; 95% CI, 0.59-0.79).
“Fifty-four % of the sufferers who obtained the mix remedy had 30% discount in albuminuria at 14 days,” Rajiv Agarwal, MD, MS, professor emeritus of medication at Indiana College Faculty of Medication and a workers doctor on the VA Medical Heart in Indianapolis, informed Healio. “This early discount of UACR was surprising.”
Lower than 5% of members in every group dropped out of the trial as a consequence of hostile occasions. Charges of hostile occasions and severe hostile occasions have been related throughout teams, in line with the researchers.
“The technique of simultaneous begin of finerenone and empagliflozin may get extra sufferers to purpose ranges of albuminuria discount in comparison with monotherapy with out rising the chance of clinically important hostile occasions,” Agarwal mentioned.
Heerspink mentioned future research ought to consider medical outcomes with longer-term use of finerenone plus an SGLT2 inhibitor.
Reference:
- Agarwal R. Session ID S 0.1. Offered at: ERA Congress; June 4-7, 2025; Vienna.
For extra info:
Rajiv Agarwal, MD, MS, will be reached at ragarwal@iu.edu.
Hiddo J. L. Heerspink, PhD, will be reached at h.j.lambers.heerspink@umcg.nl.
Sources/Disclosures
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Agarwal R, et al. N Eng J Med. 2025;doi:10.1056/NEJMoa2410659.
Disclosures:
The CONFIDENCE trial was funded by Bayer. Agarwal studies receiving private charges and nonfinancial assist from Akebia Therapeutics, Alnylam, Bayer Healthcare Prescription drugs, Boehringer Ingelheim, Chinook, Intercept, Novartis, Vera, and Vertex. Heerspink studies advisor charges from Alexion Prescription drugs, AstraZeneca, Bayer, BioCcity, Boehringer Ingelheim, Janssen, Novartis, Novo Nordisk and Roche; and grant/contract assist from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Novo Nordisk and Travere Therapeutics. Please see the examine for all different authors’ related monetary disclosures.
