(2) This program is supported by an educational grant from Bayer and is intended for #healthcare providers. Author disclosures can be found at https://t.co/2dkAx4ExXU. Prior programs, still available for CE/#CME credit, are at https://t.co/8lmzd7ADnj.
— @CKD_ce (@ckd_ce) January 19, 2022
(4) So that’s a bit of a trick question. The answer is actually both 3 (#SGLTi) and 4 (#finerenone). pic.twitter.com/1lR3GtFgCL
— @CKD_ce (@ckd_ce) January 19, 2022
6) #Canagliflozin in the CREDENCE trial (🔓https://t.co/k2190nLpss) & #dapagliflozin in the DAPA-CKD trial (🔓https://t.co/BkDuLoRsTX) showed significant ⬇️in #CKD progression in people living with T2D, PLUS ⬇️ in both #cardiovascular and #renal mortality.
— @CKD_ce (@ckd_ce) January 19, 2022
8) So, what on earth is #finerenone?! Finerenone is a non-steroidal mineralocorticoid receptor antagonist (#MRA) which has quite different pharmacokinetics and clinical effects to #spironolactone, which is a #steroidal MRA. Adverse effects of spironolactone include:
— @CKD_ce (@ckd_ce) January 19, 2022
10) Interestingly, and perhaps contributing to its beneficial effects, finerenone has established anti-inflammatory and anti-fibrotic properties. For example, see 🔓https://t.co/liYvZlJ02j.
— @CKD_ce (@ckd_ce) January 19, 2022
12) During December 2021, finerenone was given a positive opinion by the 🇪🇺European Medicines Agency for the treatment of #CKD (stage 3 & 4 with #albuminuria) associated with #T2D in adults.
— @CKD_ce (@ckd_ce) January 19, 2022
14) The 🗝️secondary endpoint was a composite of CV death, non-fatal MI, nonfatal stroke, or hospitalisation for HF #HHF. pic.twitter.com/DoRZb9IkL2
— @CKD_ce (@ckd_ce) January 19, 2022
16) However, hyperkalaemia was more frequent with finerenone than with placebo, but only 2.3% of the finerenone group discontinued therapy due to hyperkalaemia. pic.twitter.com/ujKcy0cFnA
— @CKD_ce (@ckd_ce) January 19, 2022
18) Interestingly, further data from FIDELIO-DKD presented at @ISNkidneycare 2021 by @P_Rossing looking at combinations of finerenone & SGLT2 inhibitor demonstrated a lower incidence of hyperkalaemia in SGLT2 inhibitor treated individuals with no episodes of K>6.0mmol/l. pic.twitter.com/iJZTjOE2gh
— @CKD_ce (@ckd_ce) January 19, 2022
20) On that cautionary academic note, let’s take a break. Return here TOMORROW for more education and a link to your FREE CE/#CME! Nods to @AmarPut @drpatrickholmes @HannahBeba @edgarvlermamd @scoca1 @kdjhaveri @JavedButler1 @rkramann @ayanlinaa @gabolino43 @jorgericof
— @CKD_ce (@ckd_ce) January 19, 2022
22) FIGARO-DKD explored impact of finerenone in pts with #T2D & a wider range of #CKD. Unlike FIDELIO-DKD, FIGARO-DKD (https://t.co/kSVp01OkN1) had a primary CV endpoint & a secondary renal endpoint but less advanced CKD. Nearly half had #microalbuminuria; mean eGFR was 68ml/min
— @CKD_ce (@ckd_ce) January 20, 2022
24) The primary composite endpoint was significantly ⬇️by 13% (absolute risk reduction 1.8%) with finerenone compared to placebo, mainly driven by a 29% RRR in #HHF. There was also a⬇️in ESRD.
— @CKD_ce (@ckd_ce) January 20, 2022
Other components of the primary endpoint were not significantly reduced.
26) There was no significant difference in AEs (inc #AKI & gynaecomastia) between groups, but the incidence of hyperkalaemia-related discontinuation was⬆️with finerenone (1.2%) vs placebo (0.4%)–still < expected hyperkalaemia seen w/steroidal MRAs in a similar population
— @CKD_ce (@ckd_ce) January 20, 2022
28) Notably, a recently published pre-specified analyses from FIGARO-DKD (🔓https://t.co/wYtiwlcJpK) showed that #finerenone reduced new-onset #HF and improved other clinically important HF outcomes in patients with #CKD and #T2D irrespective of a background of HF pic.twitter.com/tsiXhrXSaF
— @CKD_ce (@ckd_ce) January 20, 2022
30) But wait, there's more! FIDELITY was a pre-specified meta-analysis of individual patient data from FIDELIO-DKD & FIGARO-DKD and was presented at the virtual @escardio Congress 2021. pic.twitter.com/6wELXnD88T
— @CKD_ce (@ckd_ce) January 20, 2022
32) FIDELITY showed that finerenone significantly ⬇️risk of a composite CV outcome (time to CV death, nonfatal MI, nonfatal stroke or HHF) by 14% … AND also significantly ⬇️ risk of a composite renal outcome (≥57% decline eGFR, time to kidney failure or renal death) by 23%
— @CKD_ce (@ckd_ce) January 20, 2022
34) Well, the FIND-CKD trial is underway. Its primary outcome is the impact of finerenone on annual mean rate of change in eGFR measured by the total slope of eGFR from baseline, in ~1580 individuals with CKD but without diabetes. pic.twitter.com/aQWP6B7SsK
— @CKD_ce (@ckd_ce) January 20, 2022
36) Where might finerenone slot into future treatment paradigms for #DKD?
— @CKD_ce (@ckd_ce) January 20, 2022
The updated @goKDIGO Oct 2020 guidelines (great reference doc at 🔓https://t.co/DJ90jmYR7O) on #T2D management in #CKD already positions #SGLT2i as a pivotal part of the pyramid of treatment. pic.twitter.com/elzUVsC1ew
38) And that's it! You made it! FREE CE/#CME #physicians #physicianassociate #nurses #nursepractitioner #Pharmacist go to https://t.co/724EjW0ehk to claim your credit, and FOLLOW US for the latest education on #CKD. I am @drkevinfernando, part of the @GoggleDocs team! pic.twitter.com/Fv9jeObQLP
— @CKD_ce (@ckd_ce) January 20, 2022