Efficacy and safety of novel non-steroidal mineralocorticoid receptor antagonist finerenone in the management of diabetic kidney disease: A meta-analysis
Background: Data are scant on use of finerenone in diabetic kidney disease (DKD). We undertook this meta-analysis to address this knowledge gap. Methods: Electronic databases were searched for randomized controlled trials (RCTs) involving diabetes patients receiving finerenone compared to controls....
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2022-01-01
|
| Series: | Indian Journal of Endocrinology and Metabolism |
| Subjects: | |
| Online Access: | http://www.ijem.in/article.asp?issn=2230-8210;year=2022;volume=26;issue=3;spage=198;epage=205;aulast=Dutta |
| _version_ | 1811239408156803072 |
|---|---|
| author | Deep Dutta Vineet Surana Saptarshi Bhattacharya Sameer Aggarwal Meha Sharma |
| author_facet | Deep Dutta Vineet Surana Saptarshi Bhattacharya Sameer Aggarwal Meha Sharma |
| author_sort | Deep Dutta |
| collection | DOAJ |
| description | Background: Data are scant on use of finerenone in diabetic kidney disease (DKD). We undertook this meta-analysis to address this knowledge gap. Methods: Electronic databases were searched for randomized controlled trials (RCTs) involving diabetes patients receiving finerenone compared to controls. The primary outcome was changes in urine albumin-creatinine ratio (UACR). Secondary outcomes were time to kidney failure (decline in GFR by >40% from baseline over 4 weeks), time to end-stage kidney disease, hospitalization for any cause, death and adverse events reported. Results: From initially screened 79 articles, data from 7 RCTs involving 13,783 patients were analyzed (3 in active control group [ACG] defined as having eplerenone/spironolactone as active comparator; 4 in passive control group [PCG] defined as having placebo as controls). Patients receiving finerenone had greater percentage lowering of UACR from baseline as compared to PCG [MD23.82% (95%CI: –24.87 to –22.77); P < 0.01; I2 = 96%] at 90 days, after 2 years [MD 37.9% (95%CI: –38.09 to –37.71); P < 0.01] and 4 years [MD 25.20%(95%CI: –25.63 to –24.77);P < 0.01] of treatment. Patients receiving finerenone has lower chance of >40% decline in GFR (OR 0.83 [95%CI: 0.75 to 0.92];P < 0.01; I2 = 0%). Patients receiving finerenone had lower occurrence of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke or hospitalization for heart failure, as compared to placebo/eplerenone (OR0.86 [95%CI: 0.78 to 0.95]; P = 0.003; I2 = 0%). TAEs was similar (RR0.97 [95%CI: 0.88–1.07]; P = 0.56; I2 = 0%), but SAEs significantly lower (RR0.91 [95%CI: 0.84 to 0.97]; P < 0.01; I2 = 0%) in finerenone-group compared to controls. Conclusion: This meta-analysis provides reassuring data on beneficial impact of finerenone in reducing UACR and GFR decline as compared to placebo. We still lack head-to-head comparison of renal outcomes of finerenone vs eplerenone/spironolactone in DKD. |
| first_indexed | 2024-04-12T12:59:29Z |
| format | Article |
| id | doaj.art-85fbab2ce7644393a7eef468500b4232 |
| institution | Directory Open Access Journal |
| issn | 2230-8210 |
| language | English |
| last_indexed | 2024-04-12T12:59:29Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Endocrinology and Metabolism |
| spelling | doaj.art-85fbab2ce7644393a7eef468500b42322022-12-22T03:32:13ZengWolters Kluwer Medknow PublicationsIndian Journal of Endocrinology and Metabolism2230-82102022-01-0126319820510.4103/ijem.ijem_376_21Efficacy and safety of novel non-steroidal mineralocorticoid receptor antagonist finerenone in the management of diabetic kidney disease: A meta-analysisDeep DuttaVineet SuranaSaptarshi BhattacharyaSameer AggarwalMeha SharmaBackground: Data are scant on use of finerenone in diabetic kidney disease (DKD). We undertook this meta-analysis to address this knowledge gap. Methods: Electronic databases were searched for randomized controlled trials (RCTs) involving diabetes patients receiving finerenone compared to controls. The primary outcome was changes in urine albumin-creatinine ratio (UACR). Secondary outcomes were time to kidney failure (decline in GFR by >40% from baseline over 4 weeks), time to end-stage kidney disease, hospitalization for any cause, death and adverse events reported. Results: From initially screened 79 articles, data from 7 RCTs involving 13,783 patients were analyzed (3 in active control group [ACG] defined as having eplerenone/spironolactone as active comparator; 4 in passive control group [PCG] defined as having placebo as controls). Patients receiving finerenone had greater percentage lowering of UACR from baseline as compared to PCG [MD23.82% (95%CI: –24.87 to –22.77); P < 0.01; I2 = 96%] at 90 days, after 2 years [MD 37.9% (95%CI: –38.09 to –37.71); P < 0.01] and 4 years [MD 25.20%(95%CI: –25.63 to –24.77);P < 0.01] of treatment. Patients receiving finerenone has lower chance of >40% decline in GFR (OR 0.83 [95%CI: 0.75 to 0.92];P < 0.01; I2 = 0%). Patients receiving finerenone had lower occurrence of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke or hospitalization for heart failure, as compared to placebo/eplerenone (OR0.86 [95%CI: 0.78 to 0.95]; P = 0.003; I2 = 0%). TAEs was similar (RR0.97 [95%CI: 0.88–1.07]; P = 0.56; I2 = 0%), but SAEs significantly lower (RR0.91 [95%CI: 0.84 to 0.97]; P < 0.01; I2 = 0%) in finerenone-group compared to controls. Conclusion: This meta-analysis provides reassuring data on beneficial impact of finerenone in reducing UACR and GFR decline as compared to placebo. We still lack head-to-head comparison of renal outcomes of finerenone vs eplerenone/spironolactone in DKD.http://www.ijem.in/article.asp?issn=2230-8210;year=2022;volume=26;issue=3;spage=198;epage=205;aulast=Duttachronic kidney diseasefinerenonemeta-analysissafetytype-2 diabetes |
| spellingShingle | Deep Dutta Vineet Surana Saptarshi Bhattacharya Sameer Aggarwal Meha Sharma Efficacy and safety of novel non-steroidal mineralocorticoid receptor antagonist finerenone in the management of diabetic kidney disease: A meta-analysis Indian Journal of Endocrinology and Metabolism chronic kidney disease finerenone meta-analysis safety type-2 diabetes |
| title | Efficacy and safety of novel non-steroidal mineralocorticoid receptor antagonist finerenone in the management of diabetic kidney disease: A meta-analysis |
| title_full | Efficacy and safety of novel non-steroidal mineralocorticoid receptor antagonist finerenone in the management of diabetic kidney disease: A meta-analysis |
| title_fullStr | Efficacy and safety of novel non-steroidal mineralocorticoid receptor antagonist finerenone in the management of diabetic kidney disease: A meta-analysis |
| title_full_unstemmed | Efficacy and safety of novel non-steroidal mineralocorticoid receptor antagonist finerenone in the management of diabetic kidney disease: A meta-analysis |
| title_short | Efficacy and safety of novel non-steroidal mineralocorticoid receptor antagonist finerenone in the management of diabetic kidney disease: A meta-analysis |
| title_sort | efficacy and safety of novel non steroidal mineralocorticoid receptor antagonist finerenone in the management of diabetic kidney disease a meta analysis |
| topic | chronic kidney disease finerenone meta-analysis safety type-2 diabetes |
| url | http://www.ijem.in/article.asp?issn=2230-8210;year=2022;volume=26;issue=3;spage=198;epage=205;aulast=Dutta |
| work_keys_str_mv | AT deepdutta efficacyandsafetyofnovelnonsteroidalmineralocorticoidreceptorantagonistfinerenoneinthemanagementofdiabetickidneydiseaseametaanalysis AT vineetsurana efficacyandsafetyofnovelnonsteroidalmineralocorticoidreceptorantagonistfinerenoneinthemanagementofdiabetickidneydiseaseametaanalysis AT saptarshibhattacharya efficacyandsafetyofnovelnonsteroidalmineralocorticoidreceptorantagonistfinerenoneinthemanagementofdiabetickidneydiseaseametaanalysis AT sameeraggarwal efficacyandsafetyofnovelnonsteroidalmineralocorticoidreceptorantagonistfinerenoneinthemanagementofdiabetickidneydiseaseametaanalysis AT mehasharma efficacyandsafetyofnovelnonsteroidalmineralocorticoidreceptorantagonistfinerenoneinthemanagementofdiabetickidneydiseaseametaanalysis |