Comparison the effects of finerenone and SGLT2i on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus: A network meta-analysis

Li, Xuefeng; Wang, Hongli; Peng, Huifang; Jiang, Hongwei

doi:10.3389/fendo.2022.1078686

Cited by 10 publications

(19 citation statements)

References 25 publications

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“…The results from this presented study were in agreement with several studies, which found no significant differences in cardiovascular outcomes between dapagliflozin and empagliflozin. 17 , 18 , 19 , 20 These findings suggested a class of SGLT2 inhibitors in managing cardiovascular risks in DM patients, irrespective of the specific SGLT2 inhibitors used. However, contrasting outcomes have been observed in some studies.…”

Section: Discussionmentioning

confidence: 92%

Cardiovascular outcomes between dapagliflozin versus empagliflozin in patients with diabetes mellitus

Kim,

Yoon,

Kim

et al. 2024

Clinical Cardiology

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BackgroundSodium‐glucose co‐transporter 2 (SGLT2) inhibitors have been demonstrated to decrease cardiovascular adverse events. However, there is little real‐world clinical evidence regarding a direct comparison between dapagliflozin and empagliflozin in patients with diabetes mellitus (DM).HypothesisA difference in the cardiovascular efficancy of dapagliflozin versus empagliflozin in DM patients was anticipated, aiming to guide the optimal choice of SGLT2 inhibitors based on cardiovascular outcomes.MethodsFrom 2014 to 2020, a total of 1549 patients with DM who were prescribed SGLT2 inhibitors such as dapagliflozin or empagliflozin were retrospectively enrolled. We categorized the study population into two groups: dapagliflozin (n = 981) and empagliflozin group (n = 568). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all‐cause death, myocardial infarction (MI), stroke, or hospitalization for heart failure (HF) over a 3‐year period.ResultsPropensity‐score matching was performed (537 patients in each group). The mean age and hemoglobin A1c were 58.2 ± 13.0 years and 8.4 ± 1.7%, respectively. There was no significant difference between the dapagliflozin and empagliflozin groups in the risk of MACE (3.7% vs. 4.8%, hazard ratio [HR], 1.31; 95% confidence interval [CI], 0.73–2.35; p = 0.349). Furthermore, there were no differences between the two groups in secondary endpoints including all‐cause death, MI, stroke, and hospitalization for HF. Prior MI and history of HF were independent predictors of MACE.ConclusionsDapagliflozin and empagliflozin showed no significant difference of real‐world clinical cardiovascular outcomes in patients with DM over a 3‐year period. Further large randomized clinical trials will be warranted for better evaluation.

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Section: Discussionmentioning

confidence: 92%

Cardiovascular outcomes between dapagliflozin versus empagliflozin in patients with diabetes mellitus

Kim,

Yoon,

Kim

et al. 2024

Clinical Cardiology

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“…The study selection process is shown in Figure S1. We identified a total of 1483 records, and 25 reports were included in the final analysis. ,− Two publications were from the same original study and their data were pooled. , Thus, 24 studies, including 15 RCTs and 9 observational studies, were included. These studies were published between 2019 and 2023 and enrolled a total of 12,413 patients (6175 in the SGLT2i group and 6238 in the non-SGLT2i group).…”

Section: Resultsmentioning

confidence: 99%

Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Acute Coronary Syndrome

Song,

Liu,

et al. 2024

ACS Pharmacol. Transl. Sci.

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The evidence for sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the treatment of type 2 diabetes or chronic heart failure was sufficient but lacking in acute coronary syndrome (ACS). Our aim was to investigate the effects of SGLT2i on cardiovascular outcomes in ACS patients. Studies of SGLT2i selection in ACS patients were searched and pooled. Outcomes included all-cause death, adverse cardiovascular events, cardiac remodeling as measured by the left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD), cardiac function as assessed by the left ventricular ejection fraction (LVEF) and NT-proBNP, and glycemic control. Twenty-four studies with 12,413 patients were identified. Compared to the group without SGLT2i, SGLT2i showed benefits in reducing all-cause death (OR 0.72, 95% CI [0.61, 0.85]), major adverse cardiovascular events (MACE) (OR 0.44, 95% CI [0.30, 0.64]), cardiovascular death (OR 0.66, 95% CI [0.54, 0.81]), heart failure (OR 0.52, 95% CI [0.44, 0.62]), myocardial infarction (OR 0.68, 95% CI [0.56, 0.83]), angina pectoris (OR 0.37, 95% CI [0.17, 0.78]), and stroke (OR 0.48, 95% CI [0.24, 0.96]). Results favored SGLT2i for LVEDD (MD −2.03, 95% CI [−3.29, −0.77]), LVEF (MD 3.22, 95% CI [1.71, 4.72]), and NT-proBNP (MD −171.53, 95% CI [−260.98, −82.08]). Thus, SGLT2i treatment reduces the risk of all-cause death and MACE and improves cardiac remodeling and function in ACS patients.

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“…It can be combined with finerenone and may achieve the superposition of cardiorenal benefits effect via mechanism complementarity. The mechanism of action of SGL2i may be related to the hemodynamic effects and the decrease of albuminuria, and the kidney single-cell transcriptome data showed that SGLT2i affected mitochondrial function in proximal tubular cells [33,34]. Furthermore, SGLT2i has been shown to normalize systolic blood pressure and mitigate the development of tubular fibrosis in mice [35].…”

Section: Discussionmentioning

confidence: 99%

Cardiorenal benefits of finerenone in different races and kidney function in patients with chronic kidney disease

Li,

Cui,

et al. 2024

Cardiorenal Med

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Background: Mineralocorticoid receptor plays an important pathophysiological role in cardiorenal diseases by causing inflammation and fibrosis. Mineralocorticoid receptor antagonists (MRAs) are well known in treating cardiovascular disease and diverse nephropathies. However, the first-generation MRA (spironolactone) and the second-generation MRA (eplerenone) remain underutilized because of the risk of inducing severe adverse events. As a selective non-steroidal MRA, finerenone is safer and more effective and improves cardiorenal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). However, the effect of finerenone on cardiorenal outcomes in patients of different races and kidney function (estimated glomerular filtration rate [eGFR]) is unclear. Summary: In this review, we summarized the impact of finerenone on patients with CKD and T2DM from randomized controlled trials (RCTs) . The synthesis of published data aims to address the questions pertaining to the cardiorenal benefits of finerenone among various racial groups and different levels of kidney function. Key Message: Finerenone presents racial differences and effects associated with kidney function in CKD and T2DM patients. Due to the limited data for subgroups, it is prudent to approach the conclusion with caution.

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Comparison the effects of finerenone and SGLT2i on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus: A network meta-analysis

Cited by 10 publications

References 25 publications

Cardiovascular outcomes between dapagliflozin versus empagliflozin in patients with diabetes mellitus

Cardiovascular outcomes between dapagliflozin versus empagliflozin in patients with diabetes mellitus

Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Acute Coronary Syndrome

Cardiorenal benefits of finerenone in different races and kidney function in patients with chronic kidney disease

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