Efficacy and Safety of Finerenone in Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Zhang, Mingzhu; Bao, Wujisiguleng; Zheng, Qingyin; Wang, Yahui; Sun, Luying

doi:10.3389/fphar.2022.819327

Cited by 17 publications

(15 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although in most of genetic nephropathy the only therapeutic option is non-specific pharmacological proteinuria lowering with blockers of the renin-angiotensin-aldosterone system [ 26 ] or, more recently, with sodium-glucose cotransporter 2 inhibitors (SGLT2i) [ 27 ]. The association of CyA to the traditional anti-proteinuric therapy may represent an alternative option for patients with MAFB -associated nephropathy.…”

Section: Discussionmentioning

confidence: 99%

Multicentric Carpotarsal Osteolysis Syndrome Associated Nephropathy: Novel Variants of MAFB Gene and Literature Review

Drovandi

Lugani

Boyer

et al. 2022

JCM

View full text Add to dashboard Cite

Multicentric carpo-tarsal osteolysis (MCTO) is a rare osteolysis syndrome mainly involving carpal and tarsal bones usually presenting in early childhood. MCTO has autosomal dominant inheritance with heterozygous mutation in the MAFB gene. The skeletal disorder is often associated with chronic kidney disease. Data on clinical characterization and best treatment option of MCTO-associated nephropathy are scarce and mostly limited to case reports. With the aim to better define the phenotype and long-term outcomes of MCTO-associated nephropathy, we launched an online survey through the Workgroup for hereditary glomerulopathies of the European Rare Kidney Disease Network (ERKNet). Overall, we collected clinical and genetic data of 54 MCTO patients, of which 42 previously described and 12 new patients. We observed a high rate of kidney involvement (70%), early age of kidney disease onset, nephrotic-range proteinuria, and a kidney survival around of 40% at long-term follow-up. Our finding confirmed the heterogeneity of clinical manifestations and widen the spectrum of phenotypes resulting from MCTO-associated nephropathy. Furthermore, we report the first case of complete remission after treatment with cyclosporine A. We demonstrated that multidisciplinary care is essential for MCTO patients and early referral to nephrologists is therefore warranted to facilitate prompt treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

Multicentric Carpotarsal Osteolysis Syndrome Associated Nephropathy: Novel Variants of MAFB Gene and Literature Review

Drovandi

Lugani

Boyer

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…The phase II program ARTS (MinerAlocorticoid Receptor antagonist Tolerability Study) was conducted in CKD patients with chronic heart failure and reduced ejection fraction (HFrEF), with spirololactone as a comparator (12). There was a comparable reduction in pro-brain natriuretic peptide (NT-Pro BNP) as well as UACR, with less gynaecomastia and hyperkalaemia.…”

Section: Literature Reviewmentioning

confidence: 99%

“…The FIRAGO-DKD study was the first to show a positive cardiovascular result using a 4-point MACE (composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure) in T2D patients with established CKD (18). A meta-analysis of five RCTs by Zhang et al using the fixed effects model demonstrated a significant improvement in UACR as well as retardation of eGFR decline with finerenone compared to placebo (12). However, another meta-analysis by Fu et al with four studies using the fixed effects model demonstrated a positive impact of finerenone on UACR reduction but not on the retardation of eGFR decline (13).…”

Section: Literature Reviewmentioning

confidence: 99%

“…There were a couple of meta-analyses estimating the effectiveness of finerenone versus placebo on the renal composite as well as the individual components of urine albumin creatinine ratio (UACR) and estimated glomerular filtration rates (eGFR) (12,13). Although both meta-analyses documented similar benefits regarding renal composite, there was discordance as far as benefits on eGFR reduction were concerned.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Finerenone in type 2 diabetes and renal outcomes: A random-effects model meta-analysis

Ghosal

Sinha²

2023

Front. Endocrinol.

View full text Add to dashboard Cite

BackgroundThe nonsteroidal mineralocorticoid antagonist finerenone is a new addition to the list of agents (angiotensin converting enzyme inhibitors and sodium glucose cotransporter 2 inhibitors) conferring renal protection to patients with diabetic kidney disease. Two recent meta-analyses using the fixed effect model in patients with chronic kidney disease (both diabetic and nondiabetic populations) came to a conflicting conclusion on the effect of finerenone on eGFR decline. This meta-analysis was undertaken exclusively in the type 2 diabetes (T2D) population to explore the robustness and heterogeneity of the effect size by conducting a random effects model meta-analysis along with draft plots and prediction intervals.Materials and methodsA database search was conducted using the Cochrane library, PubMed, and Embase to identify relevant citations. Analysis was conducted on the 14th of September 2022, using RevMan 5.4.1 and RStudio (2022.07.1, Build 554). The hazard ratio was used as the effect size for the renal composite, while the standardized mean difference (SMD) was used to estimate the effect size of eGFR decline and reduction in the urine albumin creatinine ratio (UACR). The Cochrane risk-of-bias was used to assess the quality of the studies. The primary outcome assessed was the renal composite defined as kidney failure, a sustained decrease of at least 40% in the eGFR from baseline, or death from renal causes.ResultsA pooled population of 13,943 patients from four citations was included for analysis. The Cochrane risk of bias was used to assess the quality of the studies. There was a significant 16% reduction in the renal composite (kidney failure, a sustained decrease of at least 40% in the eGFR from baseline, or death from renal causes) [HR: 0.84, 95% CI 0.77-0.92, 2: 0, I2: 0%). Finerenone was also associated with reduction in UACR (SMD: -0.49, 95% CI -0.53 to -0.46, τ2: < 0.0001, I2: 0%, prediction interval: -0.57 to -0.41) and prevention of decline in eGFR (SMD: -0.32, 95% CI -0.37 to -0.27, τ2: < 0.0001, I2: 0%, prediction interval: -0.43 to -0.21) without any evidence for significant heterogeneity. Except for an increase in hyperkalaemia (RR: 2.22, 95% CI 1.93-2.24), adverse events were observed with fineronone compared to placebo (RR: 1.00, 95% CI 0.98-1.01).ConclusionThere are significant benefits in renal outcomes associated with finerenone treatment in T2D patients with established chronic kidney disease with a side effect profile comparable to placebo.

show abstract

“…(12) There were a couple of meta-analyses estimating the effectiveness of nerenone versus placebo on the renal composite as well as the individual components of urine albumin creatinine ratio (UACR) and estimated glomerular ltration rates (eGFR). (13,14) Although both meta-analyses documented similar bene ts regarding renal composite, there was discordance as far as bene ts on eGFR reduction were concerned. Moreover, of the ve included citations, one by Pitt el al did not include patients with T2D, while the other four did.…”

Section: Introductionmentioning

confidence: 99%

Finerenone in type 2 diabetes and renal outcomes: A random-effects model meta-analysis

Ghosal

Sinha

2022

Preprint

View full text Add to dashboard Cite

Background: The nonsteroidal mineralocorticoid antagonist finerenone is a new addition to the list of agents (angiotensin converting enzyme inhibitors and sodium glucose cotransporter 2 inhibitors) conferring renal protection to patients with diabetic kidney disease. Two recent meta-analyses using the fixed effect model in patients with chronic kidney disease (both diabetic and nondiabetic populations) came to a conflicting conclusion on the effect of finerenone on eGFR decline. This meta-analysis was undertaken exclusively in the type 2 diabetes (T2D) population to explore the robustness and heterogeneity of the effect size by conducting a random effects model meta-analysis along with draft plots and prediction intervals. Materials and methods: A database search was conducted using the Cochrane library to identify relevant citations. Analysis was conducted using RevMan 5.4.1 and R studio RStudio. (2022.07.1, Build 554). The hazard ratio was used as the effect size for the renal composite, while the standardized mean difference (SMD) was used to estimate the effect size of eGFR decline and reduction in the urine albumin creatinine ratio (UACR). Results: A pooled population of 13,943 patients from four citations was included for analysis. The Cochrane risk of bias was used to assess the quality of the studies. There was a significant 16% reduction in the renal composite (kidney failure, a sustained decrease of at least 40% in the eGFR from baseline, or death from renal causes) [HR: 0.84, 95% CI 0.77-0.92, t2: 0, I2: 0%). Finerenone was also associated with reduction in UACR (SMD: -0.49, 95% CI -0.53 to -0.46, t2: < 0.0001, I2: 0%, prediction interval: -0.57 to -0.41) and prevention of decline in eGFR (SMD: -0.32, 95% CI -0.37 to -0.27, t2: < 0.0001, I2: 0%, prediction interval: -0.43 to -0.21) without any evidence for significant heterogeneity. Except for an increase in hyperkalaemia (RR: 2.22, 95% CI 1.93-2.24), adverse events were observed with fineronone compared to placebo (RR: 1.00, 95% CI 0.98-1.01). Conclusion: There are significant benefits in renal outcomes associated with finerenone treatment in T2D patients with established chronic kidney disease with a side effect profile comparable to placebo.

show abstract

Efficacy and Safety of Finerenone in Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Cited by 17 publications

References 44 publications

Multicentric Carpotarsal Osteolysis Syndrome Associated Nephropathy: Novel Variants of MAFB Gene and Literature Review

Multicentric Carpotarsal Osteolysis Syndrome Associated Nephropathy: Novel Variants of MAFB Gene and Literature Review

Finerenone in type 2 diabetes and renal outcomes: A random-effects model meta-analysis

Finerenone in type 2 diabetes and renal outcomes: A random-effects model meta-analysis

Contact Info

Product

Resources

About