Finerenone with Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes (CONFIDENCE)
Starting the kidney-protective drugs finerenone and empagliflozin together lowered urine protein more than starting either one alone in people with diabetic kidney disease, and was well tolerated.
Background
Finerenone and SGLT2 inhibitors each independently slow CKD progression and reduce cardiovascular risk, but evidence on starting both at the same time, rather than adding one after the other, was limited. CONFIDENCE tested simultaneous initiation in people with CKD and type 2 diabetes already on a renin-angiotensin system inhibitor.
Study design
Participants with eGFR 30-90 mL/min/1.73m2, urinary albumin-to-creatinine ratio 100 to <=5000 mg/g, and type 2 diabetes were randomized 1:1:1 to finerenone alone, empagliflozin 10 mg alone, or the combination. The primary outcome was the relative change in log-transformed urinary albumin-to-creatinine ratio from baseline to day 180.
Key findings
At day 180 the albuminuria reduction with combination therapy was 29% greater than finerenone alone (ratio 0.71, 95% CI 0.61-0.82) and 32% greater than empagliflozin alone (ratio 0.68, 95% CI 0.59-0.79; both P<0.001).
Safety
Neither agent alone nor in combination produced unexpected adverse events. Symptomatic hypotension, acute kidney injury, and hyperkalemia leading to drug discontinuation were uncommon.
Category
Research
Source
The New England Journal of Medicine
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