Background and Aims: Finerenone, a nonsteroidal MR antagonist
(MRA), enhances renal and cardiovascular outcomes in patients with type
2 diabetes (T2DM). Finerenone’s safety and effectiveness in renal
function are debatable. This meta-analysis evaluates the efficacy and
safety of treatments for patients with diabetic kidney disease.
Methods: To find relevant RCTs, the databases PubMed, Embase,
and Google Scholar were searched. Finerenone’s effects were quantified
using estimated pooled mean differences (MDs) and relative risks with
95% confidence intervals (CIs).
Results: This meta-analysis combines seven double-blind trials
involving patients with CKD and type 2 diabetes who were randomly
assigned to finerenone or placebo. The primary efficacy time-to-event
outcomes were cardiovascular death, non-fatal myocardial infarction,
non-fatal stroke, heart failure hospitalization, kidney failure, a
sustained 57% decrease in estimated glomerular filtration rate from
baseline over 4 weeks, or renal death. In this meta-analysis of 39,995
patients, treatment with Finerenone was associated with a lower risk of
death due to cardiovascular and renal outcomes than placebo (RR = 0.86
[0.80, 0.93] p=0.0002; I2= 0%) and (RR = 0.56 [0.17, 1.82]
p=0.34; I2= 0%), respectively. Finerenone treatment was also associated
with a marginally lower risk of serious adverse events (RR = 0.95
[0.92, 0.97] p 0.0001; I2= 0%), but no overall difference in the
risk of adverse events was found between the two groups (RR = 1.00
[0.99, 1.01] p=0.56; I2= 0%).
Conclusion: The administration of finerenone decreases the
likelihood of end-stage kidney disease, renal failure, cardiovascular
death, and hospitalization. Therefore, we propose that patients with
T2DM and CKD undergo finerenone therapy.
Keywords: Diabetes, Chronic kidney disease, CKD, Cardiovascular
disease, Finerenone, Non-steroidal Mineralocorticoid receptor
antagonist, Meta-analysis, Systematic review