Key result
SGLT2i cuts renal events ~22% vs finerenone and outperforms GLP-1 RA in T2DM and CKD.
Why the study?
To evaluate and indirectly compare the cardiovascular and renal benefits of finerenone, SGLT2 inhibitors, and GLP-1 receptor agonists in patients with T2DM and CKD.
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?
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.
Answers are grounded in this paper and cite their sources.
Supports preferring SGLT2 inhibitors for renal protection in T2DM with CKD; extends indirect comparisons versus finerenone.
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.
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Zhang et al. (2022) 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 decreased the risk of renal events compared with finerenone and GLP-1 RA in patients with T2DM and CKD.
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