Impact of Baseline GLP-1 Receptor Agonist Use on Albuminuria Reduction and Safety With Simultaneous Initiation of Finerenone and Empagliflozin in Type 2 Diabetes and Chronic Kidney Disease (CONFIDENCE Trial)
In the CONFIDENCE trial, starting finerenone and an SGLT2 inhibitor together cut urine protein more than either drug alone, and this benefit held whether or not patients were already taking a GLP-1 weight/diabetes medicine.
Background
Finerenone, SGLT2 inhibitors, and GLP-1 receptor agonists each independently lower cardiorenal risk in type 2 diabetes with chronic kidney disease, but how they should be combined is unsettled. The CONFIDENCE trial tested whether starting finerenone and the SGLT2 inhibitor empagliflozin at the same time is more effective than either alone. This prespecified analysis asked whether outcomes differ by whether patients were already on a GLP-1 receptor agonist.
Key findings
Among 800 randomized participants (UACR 100 to <5,000 mg/g; eGFR 30-90), combination therapy reduced urinary albumin-to-creatinine ratio at day 180 by about 51% in GLP-1 RA users and 56% in non-users, exceeding the roughly one-third reductions seen with either monotherapy. eGFR changes were consistent across subgroups and acute kidney injury was uncommon.
Clinical implications
These results support simultaneous, rather than sequential, initiation of finerenone and an SGLT2 inhibitor for albuminuric diabetic CKD, and suggest the strategy is effective and well tolerated on top of existing GLP-1 receptor agonist therapy, advancing combination cardiorenal protection.
Safety
Hyperkalemia incidence with combination therapy was similar with and without baseline GLP-1 RA use (9.0% vs 9.5%). Blood pressure reductions were more pronounced with combination therapy. No new safety signals were identified.
Category
Research
Source
Diabetes Care
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