Network meta-analysis of finerenone versus SGLT2 inhibitors and GLP-1 receptor agonists on cardiovascular and renal outcomes in type 2 diabetes and chronic kidney disease
In a network meta-analysis of patients with type 2 diabetes and CKD, finerenone, SGLT2 inhibitors, and GLP-1 receptor agonists were comparable for major adverse cardiovascular events, but SGLT2 inhibitors significantly reduced renal events and heart failure hospitalisation more than finerenone or GLP-1 receptor agonists.
Background
Finerenone, SGLT2 inhibitors, and GLP-1 receptor agonists each improve cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and chronic kidney disease, but head-to-head comparisons of their relative efficacy are limited. A network meta-analysis allows indirect comparison of these agents across cardiovascular and renal endpoints.
Study design
Systematic searches identified randomized controlled trials comparing finerenone, SGLT2 inhibitors, and GLP-1 receptor agonists in diabetic patients with CKD. Eighteen RCTs involving 51,496 patients were included, and results were reported as risk ratios with 95% confidence intervals for major adverse cardiovascular events (MACE), renal outcomes, and hospitalization for heart failure.
Key findings
Versus placebo, finerenone reduced MACE (RR 0.88, 0.80-0.97), renal outcomes (0.86, 0.79-0.93), and heart failure hospitalisation (0.79, 0.67-0.92); SGLT2 inhibitors reduced MACE (0.84, 0.78-0.90), renal outcomes (0.67, 0.60-0.74), heart failure hospitalisation (0.60, 0.53-0.68), all-cause death (0.89, 0.81-0.91), and cardiovascular death (0.86, 0.77-0.96); GLP-1 receptor agonists reduced MACE (0.86, 0.78-0.94). In indirect comparisons, SGLT2 inhibitors were significantly superior to both finerenone and GLP-1 receptor agonists for renal outcomes and heart failure hospitalisation, while the three classes were comparable for MACE, all-cause death, and cardiovascular death.
Clinical implications
All three drug classes confer broadly comparable protection against major cardiovascular events in type 2 diabetes with CKD, but SGLT2 inhibitors provide the greatest reduction in renal events and heart failure hospitalisation among the agents compared. These findings support prioritising SGLT2 inhibitors for kidney and heart failure protection, while recognising the value of finerenone and GLP-1 receptor agonists within a layered treatment approach.
Category
Research
Source
Cardiovascular Diabetology
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