Efficacy and Safety of finerenone therapy in patients with cardiovascular and chronic kidney diseases in type 2 diabetes mellitus: a systematic review and meta-analysis    

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