Efficacy of combined sodium-glucose cotransporter 2 inhibitors and finerenone in chronic kidney disease: a systematic review and meta-analysis
Abstract
Background: Sodium-glucose cotransporter two inhibitors (SGLT2is) and finerenone have demonstrated individual efficacy in reducing cardiorenal events among patients with diabetic chronic kidney disease (CKD). However, the additive benefits and safety profile of combining these agents remain unclear.
Methods: We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies comparing finerenone plus SGLT2is versus monotherapy. Primary outcomes included all-cause mortality, major adverse cardiovascular events (MACEs), kidney-specific composite outcomes, and hyperkalemia risk. Pooled odds ratios (OR) and 95% confidence intervals (CIs) were calculated using a random-effects model.
Results: A total of eight studies (N = 1,580) were included. Compared with finerenone monotherapy, combination therapy significantly reduced all-cause mortality (OR 0.58; 95% CI: 0.36-0.93). Furthermore, combination therapy also reduced MACE risk (OR 0.70; 95% CI: 0.51-0.97) and major adverse kidney event (MAKE) risk (OR 0.63; 95% CI: 0.44-0.89) compared with finerenone monotherapy. Combination therapy significantly reduced urinary albumin-creatinine ratio (UACR) more than finerenone monotherapy, with a mean difference of 0.10 (equivalent to a 10% greater reduction; combination vs. finerenone, 95% CI: 0.00-0.19; p = 0.045). However, the combined group had a higher risk of hyperkalemia compared to SGLT2i monotherapy (OR 3.00; 95%: CI 2.50-3.61). No significant…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,580 participants or records.
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