Finerenone confers cardiorenal benefits in Chinese CKD, T2D patients

In the subgroup analysis of the phase III FIGARO-DKD trial, the selective nonsteroidal mineralocorticoid receptor antagonist finerenone conferred cardiorenal benefits in Chinese patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). The findings were consistent with that observed in the overall cohort.

“In [the total population], finerenone demonstrated kidney and heart benefits. It delayed CKD progression and reduced the risk of cardiovascular (CV) events,” noted Dr Katja Rohwedder from Bayer AG, who presented on behalf of study investigator Dr Ping Li from Nanjing Drum Tower Hospital, Nanjing, China, at EASD 2023.

The hazard ratios (HRs) for the kidney* and CV** composite outcomes were 0.87 (95 percent confidence interval [CI], 0.76–1.01; p=0.0689) and 0.87 (95 percent CI, 0.76–0.98; p=0.0264). The CV composite outcome was primarily driven by hospitalization for heart failure (hHF; HR, 0.71, 95 percent CI, 0.56–0.90; p=0.0043). [N Engl J Med 2021;85;2252-2263]

In the current analysis, finerenone treatment significantly reduced the risk of the composite kidney outcome and its components compared with placebo in Chinese patients with stage 1–4 CKD with moderate-to-severe albuminuria, well-controlled systolic blood pressure and HbA_1c who were treated with optimized renin-angiotensin system blockade. [EASD 2023, abstract 701]

“In this cohort of patients who had a high risk for renal events, there was a more pronounced effect on the kidney endpoint,” said Rohwedder. The relative risk was halved (HR, 0.48, 95 percent CI, 0.29–0.79; p=0029).

“Considering that patients [had] an eGFR*** of >70 mL/min/1.73 m² at baseline and after 3 years of follow-up, there were a lot of patients ending up with end-stage kidney disease (ESKD) especially in the placebo arm, [whereas] in the finerenone arm, there was a very good reduction (n=12 vs 4),” she continued.

There was also a numerical reduction in the CV endpoint (HR, 0.91, 95 percent CI, 0.50–1.67; p=0.7660).

The significant reduction in urine albumin-to-creatinine ratio seen at month 4 from baseline (least squares mean, 0.61, 95 percent CI, 0.53–0.70) was maintained for the duration of the study.

In the total population, the rate of any hyperkalaemia events was higher with finerenone than placebo (9.1 percent vs 4.4 percent), but in the Chinese subgroup, the rates were similar (17.3 percent vs 16.0 percent). The safety profile of finerenone was generally similar between the total cohort and the Chinese subgroup.

A much needed therapeutic alternative

In FIGARO-DKD, patients with early to middle stage CKD and T2D were randomized 1:1 to receive finerenone 10 or 20 mg once daily or placebo. Of these, 325 were Chinese. About three-quarters of the Chinese cohort were male. Median follow-up was 3.4 years.

This is a very special population, noted Rohwedder, given the high prevalence of CKD in Chinese patients. More than 80 million adults in China has CKD, translating to an estimated prevalence of 8.2 percent. [JAMA Intern Med 2023;183:298-310]

“More importantly, Chinese CKD patients tend to experience more rapid deterioration in kidney function vs Caucasian patients,” she continued. “Finerenone provides a much needed therapeutic option to many Chinese patients with CKD.”