SGLT2 inhibitors significantly decreased the risk of renal events compared with finerenone (finerenone vs SGLT2i RR 1.29; 95% CI 1.13-1.47) and GLP-1 RA in patients with T2DM and CKD.
Meta-Analysis (n=51,496)
Do finerenone, SGLT2 inhibitors, and GLP-1 receptor agonists reduce cardiovascular and renal events in patients with type 2 diabetes mellitus and chronic kidney disease?
In patients with T2DM and CKD, SGLT2 inhibitors provide superior reduction in renal events and heart failure hospitalizations compared to finerenone and GLP-1 receptor agonists, while all three offer comparable benefits for MACE and mortality.
Effect estimate: RR 0.88 (95% CI 0.80-0.97)
OBJECTIVE: To evaluate the cardiovascular and renal benefits of finerenone, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagonlike peptide-1 receptor agonists (GLP-1 RA) in patients with Type 2 Diabetes Mellitus (T2DM) and chronic kidney disease (CKD) with network meta-analysis. METHODS: Systematic literature searches were conducted of PubMed, Cochrane Library, Web of Science, Medline and Embase covering January 1, 2000 to December 30, 2021. Randomized control trials (RCTs) comparing finerenone, SGLT-2i and GLP-1 RA in diabetics with CKD were selected. We performed a network meta-analysis to compare the two drugs and finerenone indirectly. Results were reported as risk ratio (RR) with corresponding 95% confidence interval (CI). RESULTS: 18 RCTs involving 51,496 patients were included. Finerenone reduced the risk of major adverse cardiovascular events (MACE), renal outcome and hospitalization for heart failure (HHF) (RR 95% CI; 0.88 0.80-0.97, 0.86 0.79-0.93, 0.79 0.67,0.92, respectively). SGLT-2i were associated with reduced risks of MACE (RR 95% CI; 0.84 0.78-0.90), renal outcome (RR 95% CI; 0.67 0.60-0.74, HHF (RR 95% CI; 0.60 0.53-0.68), all-cause death (ACD) (RR 95% CI; 0.89 0.81-0.91) and cardiovascular death (CVD) (RR 95% CI; 0.86 0.77-0.96) compared to placebo. GLP-1 RA were associated with a lower risk of MACE (RR 95% CI; 0.86 0.78-0.94). SGLT2i had significant effect in comparison to finerenone (finerenone vs SGLT2i: RR 95% CI; 1.29 1.13-1.47, 1.31 1.07-1.61, respectively) and GLP-1 RA (GLP-1 RA vs SGLT2i: RR 95% CI; 1.36 1.16-1.59, 1.49 1.18-1.89, respectively) in renal outcome and HHF. CONCLUSIONS: In patients with T2DM and CKD, SGLT2i, GLP-1 RA and finerenone were comparable in MACE, ACD and CVD. SGLT2i significantly decreased the risk of renal events and HHF compared with finerenone and GLP-1 RA. Among GLP-1 RA, GLP-1 analogues showed significant effect in reducing cardiovascular events compared with exendin-4 analogues.
Zhang et al. (Sat,) conducted a meta-analysis in Type 2 Diabetes Mellitus and chronic kidney disease (n=51,496). Finerenone, SGLT2 inhibitors, and GLP-1 receptor agonists vs. Placebo and active comparators was evaluated on Major adverse cardiovascular events (MACE) for finerenone vs placebo (RR 0.88, 95% CI 0.80-0.97). SGLT2 inhibitors significantly decreased the risk of renal events compared with finerenone (finerenone vs SGLT2i RR 1.29; 95% CI 1.13-1.47) and GLP-1 RA in patients with T2DM and CKD.
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