Efficacy and safety of finerenone with SGLT2i in IgA nephropathy

BACKGROUND: This study aimed to compare the renal protective effects and safety profile of finerenone plus sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapy versus monotherapy in patients with immunoglobulin A (IgA) nephropathy. METHODS: The retrospective study evaluated 76 patients with biopsy-proven IgA nephropathy at the First Affiliated Hospital of Zhengzhou University (2023-24). Participants were divided into three groups: finerenone plus SGLT2i group (n = 26), finerenone monotherapy group (n = 32) and SGLT2i monotherapy group (n = 18). Changes in urinary protein-to-creatinine ratio (UPCR) and estimated glomerular filtration rate at 3 and 6 months were evaluated. Safety assessments focused on hyperkalemia incidence and treatment-emergent adverse events. RESULTS: The combination therapy demonstrated superior proteinuria reduction compared with monotherapies, with median UPCR reductions of 40.89% at Month 3 and 54.62% at Month 6 versus 23.72%/30.88% (finerenone) and 24.69%/24.69% (SGLT2i) (all P < .05). Significantly more patients achieved ≥50% UPCR reduction in the finerenone plus SGLT2i group at Month 6 (53.8% vs 25.0% and 22.2%, P = .033). Logistic regression analysis demonstrated adjusted odds ratios ranging from 3.87 to 18.90 for finerenone plus SGLT2i therapy achieving ≥50% proteinuria reduction (all P < .05). Renal function parameters remained stable in all treatment groups without significant intergroup differences (all P > .05). The safety profile showed comparable hyperkalemia incidence rates between groups (P = .332). No severe adverse events or treatment withdrawals attributable to hyperkalemia were observed. CONCLUSION: Our study shows that combined finerenone-SGLT2i therapy has a more rapid and superior proteinuria reduction versus monotherapy in IgA nephropathy, with preserved renal function and good safety.