Finerenone + Empagliflozin Offers Greater Benefit in CKD, T2DM

MONDAY, June 9, 2025 (HealthDay News) — For patients with chronic kidney disease and type 2 diabetes, combination finerenone plus empagliflozin leads to a greater reduction in the urinary albumin-to-creatinine ratio than either agent alone, according to a study published online June 5 in the New England Journal of Medicine to coincide with the annual congress of the European Renal Association, held from June 4 to 7 in Vienna.

Rajiv Agarwal, M.D., from the Richard L. Roudebush VA Medical Center in Indianapolis, and colleagues randomly assigned participants with chronic kidney disease (estimated glomerular filtration rate, 30 to 90 mL per minute per 1.73 m² of body-surface area), albuminuria, and type 2 diabetes, who were taking a renin-angiotensin system inhibitor, to receive finerenone at a dose of 10 or 20 mg per day (with empagliflozin-matching placebo), empagliflozin at a dose of 10 mg per day (with finerenone-matching placebo), or a combination of finerenone and empagliflozin (258, 261, and 265 patients, respectively).

The baseline median urinary albumin-to-creatinine ratio was 579 and was similar among the three groups. The researchers found that at day 180, the reduction in the urinary albumin-to-creatinine ratio with combination therapy was 29 and 32 percent greater than with finerenone alone and empagliflozin alone, respectively (least-squares mean ratio of the difference in the change from baseline, 0.71 and 0.68, respectively). Neither agent led to unexpected adverse events, alone or in combination. Symptomatic hypotension, acute kidney injury, and hyperkalemia rarely led to drug discontinuation.

“The CONFIDENCE study delivers the clear message that simultaneous initiation of finerenone and empagliflozin led to an early and additive reduction in urinary albumin-to-creatinine ratio of 52 percent in patients with chronic kidney disease and type 2 diabetes, which was significantly greater than with either treatment alone,” Agarwal said in a statement. “Since urinary albumin-to-creatinine ratio is a key mediator of kidney and cardiovascular outcomes, these results are highly relevant for clinical decision-making.”

Several authors disclosed ties to Bayer, which manufactures finerenone and funded the study.

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