Efficacy and safety of finerenone in patients with chronic kidney disease: a systematic review with meta-analysis and trial sequential analysis

Abstract

Background: The efficacy and safety of finerenone are unknown. Therefore, we performed this metaanalysis to investigate the efficacy and safety of finerenone in patients with chronic kidney disease (CKD).Methods: We systematically searched for relevant studies in the PubMed, Embase and Cochrane Library databases from database inception until December 2020. We selected randomized controlled trials assessing finerenone treatment in patients with CKD.Results: Four trials (n=7,048) met the inclusion criteria. Compared with placebo, finerenone significantly reduced the urine albumin-to-creatinine ratio (UACR) in patients with CKD {mean difference (MD), −0.30 [95% confidence interval (CI), −0.50, −0.11], P<0.05}, and trial sequential analysis (TSA) confirmed this result. No significant difference was observed in eGFR in patients with CKD between the finerenone and placebo groups [MD, −0.90 (95% CI, −3.84 to 2.04), P>0.05]. Overall, the frequency of adverse events was similar in the two groups [relative risk (RR), 1. 00 (95% CI, 0.98, 1.02), P>0.05], and TSA confirmed this result. However, the finerenone group exhibited a lower risk of cardiovascular disorders and a higher risk of hyperkalemia than the placebo group [RR, 0.92 (95% CI, 0.85, 0.99), P<0.05 and RR, 2.04 (95% CI, 1.77, 2.34), P<0.00001, respectively].Discussion: This meta-analysis indicated that finerenone confers an important antiproteinuric effect on patients with CKD and reduces the risk of cardiovascular disorders in these patients. Finerenone may be a promising therapy option for patients with CKD. PROSPERO registration number: CRD42021222404

Efficacy and Safety of Non-Steroidal Mineralocorticoid Receptor Antagonists in Patients With Chronic Kidney Disease and Type 2 Diabetes: A Systematic Review Incorporating an Indirect Comparisons Meta-Analysis

“…The results of this meta-analysis found that finerenone, apararenone, and esaxerenone all can decrease the UACR in patients with CKD and T2D. This finding about finerenone is in line with a previous meta-analysis ( Fu et al, 2021 ). However, the esaxerenone subgroup showed significant statistical heterogeneity (I 2 = 85.6%), which may result from the different treatment durations (12 vs. 52 weeks).…”

“…This study indicates that the use of non-steroidal MRAs (finerenone and esaxerenone) in patients with CKD and T2D may lead to decreased eGFR. In contrast, the previous meta-analysis showed that finerenone did not significantly decrease the eGFR in patients with CKD ( Fu et al, 2021 ). We found that there was significant heterogeneity (I 2 = 86%) among the included studies, and a significant difference was found in changes in eGFR between the finerenone group and the placebo group after excluding one study ( p = 0.01, I 2 = 0%) ( Fu et al, 2021 ).…”

“…In contrast, the previous meta-analysis showed that finerenone did not significantly decrease the eGFR in patients with CKD ( Fu et al, 2021 ). We found that there was significant heterogeneity (I 2 = 86%) among the included studies, and a significant difference was found in changes in eGFR between the finerenone group and the placebo group after excluding one study ( p = 0.01, I 2 = 0%) ( Fu et al, 2021 ). Due to the limited number of included studies, they finally reported the former results.…”

“…For the included dose regimens, the finerenone group selected 10 and 20 mg/d; the esaxerenone group selected 1.25, 2.5, and 5 mg/d; and the apararenone group selected 2.5, 5, and 10 mg/d. The selections of these dose regimens were according to previous studies ( Al Dhaybi and Bakris, 2020 ; Fu et al, 2021 ). For each outcome in each drug, these dose groups were combined into one group, which showed the pooled results.…”

Meta-Analysis of the Efficacy and Safety of Finerenone in Diabetic Kidney Disease

“…As the third generation of the nonsteroidal mineralocorticoid receptor antagonist drug, finerenone demonstrates better protective effects on cardiorenal function compared with spironolactone or eplerenone due to the balanced tissue distribution into the heart and kidney [14-18], as well as a lower incidence of adverse events such as hyperkalemia [14]. In recent years, various research studies were conducted on the clinical effectiveness and safety of finerenone in cardiovascular and kidney diseases [19, 20]. Owing to a lack of relevant reviews reporting the efficacy and safety of finerenone on the renal function of DKD patients, this meta-analysis of randomized, placebo-controlled trials was conducted to evaluate the efficacy and safety of oral finerenone as a treatment for DKD.…”