Key result
Finerenone reduced the risk of new-onset atrial fibrillation by 21% compared to placebo (RR 0.79) in patients with type 2 diabetes and chronic kidney disease, while indirect comparisons showed no significant difference between finerenone and SGLT2 inhibitors.
Why the study?
The comparative efficacy and safety of finerenone versus SGLT2 inhibitors for reducing new-onset atrial fibrillation in patients with T2DM and CKD had not been established.
Does finerenone or SGLT2 inhibitors reduce new-onset atrial fibrillation in patients with type 2 diabetes mellitus and chronic kidney disease?
Meta-Analysis (n=35,841)
Does finerenone or SGLT2 inhibitors reduce new-onset atrial fibrillation in patients with type 2 diabetes mellitus and chronic kidney disease?
Relative Risk: 0.79 (95% CI 0.62–0.99)
In patients with T2DM and CKD, finerenone reduces the risk of new-onset atrial fibrillation compared to placebo, but indirect comparisons show no significant difference between finerenone and SGLT2 inhibitors.
OBJECTIVE: To evaluate the efficacy and safety of finerenone and sodium-glucose cotransporter-2 inhibitors (SGLT2i) on reducing new-onset of atrial fibrillation (AF) in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). METHOD: We searched the PubMed, Cochrane Library, Web of Science, Medline and Embase covering January 1, 2000 to April 30, 2022. Randomized control trials comparing finerenone or SGLT2i with placebo in patients with T2DM and CKD were selected. Results were reported as risk ratio (RR) with corresponding 95% confidence interval (CI). RESULTS: A total of 10 studies (35,841 patients) were included. Finerenone (RR 0.79, 95% CI 0.62-0.99) was associated with a decreased risk of AF compared with placebo, while SGLT2i were not. SGLT2i were associated with a decreased risk of hospitalization for heart failure (RR 0.78, 95% CI 0.63-0.98) compared with finerenone. They were comparable in AF(RR 0.84, 95% CI 0.48,1.46), major adverse cardiovascular events(MACE) (RR 0.93, 95% CI 0.81,1.06) and nonfatal stroke(RR 0.78, 95% CI 0.58,1.05). They both showed no significant risk of adverse events compared with placebo. CONCLUSION: There was no significant difference in the reduction of new-onset of atrial fibrillation between Finerenone and SGLT2i based on the indirect comparisons of currently available clinical studies. The large-sampled head-to-head trials was needed for the more precise conclusion.
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Zhang et al. (2022) conducted a meta-analysis in Type 2 diabetes mellitus and chronic kidney disease (n=35,841). Finerenone vs. Placebo was evaluated on New-onset atrial fibrillation (RR 0.79, 95% CI 0.62-0.99). Finerenone reduced the risk of new-onset atrial fibrillation by 21% compared to placebo (RR 0.79) in patients with type 2 diabetes and chronic kidney disease, while indirect comparisons showed no significant difference between finerenone and SGLT2 inhibitors.
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