Although earlier research has shown that finerenone improves kidney and cardiovascular outcomes in patients with type 2 diabetes and CKD, use of the medication has not been evaluated in people with type 1 diabetes and CKD.
Participants received either an angiotensin receptor blocker or an angiotensin-converting enzyme inhibitor.
The UACR was reduced from 574.6 mg/g at baseline to 373.5 mg/g at 6 months among participants who received finerenone, and from 506.4 mg/g to 475.6 mg/g among those who received placebo.
In addition, at 6 months, the finerenone group experienced an eGFR change of −5.6 mL/min/1.73 m2, while the placebo group experienced a change of −2.7 mL/min/1.73 m2, a difference of 2.9 mL/min/1.73 m2.
The most frequent adverse event was hyperkalemia, occurring in 10.1% of participants in the finerenone group and in 3.3% of participants receiving placebo, with 1.7% requiring discontinuation for this reason.
Although earlier research has shown that finerenone improves kidney and cardiovascular outcomes in patients with type 2 diabetes and CKD, use of the medication has not been evaluated in people with type 1 diabetes and CKD. To address the gap, Hiddo J. L. Heerspink, PhD, and colleagues examined the use of finerenone in this population and determined that it is effective.
Their phase 3 clinical trial included 242 adults with type 1 diabetes, CKD (estimated glomerular filtration rate [eGFR] of 25 to <90 mL/min/1.73 m2), and albuminuria (urinary albumin-to-creatinine ratio [UACR] of 200 to <5,000 mg/g). Participants received either an angiotensin receptor blocker or an angiotensin-converting enzyme inhibitor. Investigators randomly assigned them to receive finerenone (10 or 20 mg per day, depending on the eGFR) or a placebo. The primary outcome was the relative change in UACR over 6 months.
The UACR was reduced from 574.6 mg/g at baseline to 373.5 mg/g at 6 months among participants who received finerenone, and from 506.4 mg/g to 475.6 mg/g among those who received placebo. This indicates that finerenone produced a 25% larger reduction than the placebo.
In addition, at 6 months, the finerenone group experienced an eGFR change of −5.6 mL/min/1.73 m2, while the placebo group experienced a change of −2.7 mL/min/1.73 m2, a difference of 2.9 mL/min/1.73 m2.
The most frequent adverse event was hyperkalemia, occurring in 10.1% of participants in the finerenone group and in 3.3% of participants receiving placebo, with 1.7% requiring discontinuation for this reason.
The researchers concluded that finerenone produced a significantly larger reduction in UACR than the placebo.
