1) Welcome to a joint-accredited tweetorial on a new therapeutic option to reduce the progression of diabetic kidney disease: finerenone – a non-steroidal mineralocorticoid receptor antagonist. I am @drkevinfernando. #FOAMed pic.twitter.com/qMnX0VWiuL
— cardio-met (@cardiomet_CE) May 4, 2021
3) So, OK, FINERENONE. We’ll discuss what it is, what evidence supports it use, and where it might fit into future renal guidelines
— cardio-met (@cardiomet_CE) May 4, 2021
5) The answer is diabetes, based in findings from the UK Renal Registry 2020 (https://t.co/Do4sjSaHoy). Furthermore, a recent UK national diabetes audit reported that 42.3% of people living with type 2 diabetes and 32.4% with type 1 diabetes also had a diagnosis . . .
— cardio-met (@cardiomet_CE) May 4, 2021
7) The following therapeutic options have demonstrated a significant reduction in the progression of CKD and cardiovascular mortality in people living with type 2 diabetes:
— cardio-met (@cardiomet_CE) May 4, 2021
9) Seminal renal trials such as RENAAL (Brenner et al, NEJM 2001;345-861-9) and IDNT (Lewis et al, NEJM 2001;345:851-60) have demonstrated significant reductions in the progression of CKD with RAAS blockade with losartan and irbesartan respectively.
— cardio-met (@cardiomet_CE) May 4, 2021
11) . . . showed significant reductions in CKD progression in people living with type 2 diabetes as well as reductions in both cardiovascular and renal mortality. Notably DAPA-CKD also demonstrated these benefits in people without type 2 diabetes.
— cardio-met (@cardiomet_CE) May 4, 2021
13) Adverse effects of spironolactone include:
— cardio-met (@cardiomet_CE) May 4, 2021
15) Welcome back to our accredited tweetorial on the potential of finerenone to reduce the progression of DKD. I am @drkevinfernando. The answer to our poll is . . . all of the above!
— cardio-met (@cardiomet_CE) May 5, 2021
17) Interestingly, and perhaps contributing to its beneficial effects, finerenone has established anti-inflammatory and anti-fibrotic properties.
— cardio-met (@cardiomet_CE) May 5, 2021
Of note, finerenone is not yet commercially available.
19) FIDELIO-DKD has a primary renal endpoint with secondary cardiac endpoints, while FIGARO-DKD has a primary cardiac endpoint and secondary renal endpoints with less advanced CKD. FIDELIO-DKD has recently published its results and FIGARO-DKD is due to complete later in 2021.
— cardio-met (@cardiomet_CE) May 5, 2021
21) The primary composite endpoint was significantly reduced by 18% (absolute risk reduction 3.3%) with finerenone compared to placebo, and the secondary endpoint by 14% (ARR 1.8%). There was no imbalance in adverse effects such as acute kidney injury or hypotension.
— cardio-met (@cardiomet_CE) May 5, 2021
23) Notably, finerenone reduced albuminuria to a similar extent as SGLT2 inhibitors, but the magnitude of benefit observed in the primary composite outcome was less than CREDENCE and DPA-CKD (18% versus 30% and 39% respectively)
— cardio-met (@cardiomet_CE) May 5, 2021
25) Additionally and importantly, only 5% of trial participants in FIDELIO-DKD were also treated with #SGLT2 inhibitors.
— cardio-met (@cardiomet_CE) May 5, 2021
27) Welcome back to our accredited tweetorial on finerenone. I am @drkevinfernando and I am all about #diabetes management in #primarycare. Thanks for joining me, and shout outs to @pcdsociety @diabetespc @Roxytonin as well! Please follow us!
— cardio-met (@cardiomet_CE) May 6, 2021
29) Where might finerenone slot into future treatment paradigms for DKD? The updated @goKDIGO October 2020 guidelines (great reference document at https://t.co/m8W2VFEKXr) on DM2 management in CKD . . . pic.twitter.com/R7HcETD5pt
— cardio-met (@cardiomet_CE) May 6, 2021
31) On the basis of FIDELIO-DKD, finerenone also appears to deserve its own slot alongside RAAS blockade and SGLT2 inhibition and we await the results of FIGARO-DKD to add to the evidence base for the benefits of finerenone.
— cardio-met (@cardiomet_CE) May 6, 2021
33) That's it! You made it! Free CE/CME! Now go to https://t.co/2VlYbqop2w and claim your credit from @academiccme! I am @drkevinfernando. Follow @cardiomet_CE for more tweetorials! #medtwittter #cardiotwitter @MedTweetorials #FOAMed
— cardio-met (@cardiomet_CE) May 6, 2021