Finerenone reduces the risk of AF onset in patients with CKD and diabetes

An analysis of the FIDELIO-DKD trial demonstrated that finerenone decreased new-onset atrial fibrillation or flutter (AFF) in patients who have type 2 diabetes (T2D) and chronic kidney disease (CKD) irrespective of AFF history at baseline [1,2].

T2D and CKD are both promoters of AFF via structural and/or electrical remodelling, which is triggered by activation of mineralocorticoid receptors. Finerenone is a novel, non-steroidal, selective mineralocorticoid receptor antagonist with anti-inflammatory and anti-fibrotic effects.

Prof. Gerasimos Filippatos (Attikon University Hospital, Greece) presented a prespecified analysis of the FIDELIO-DKD trial (NCT02540993) [1]. The analysis examined the cardiorenal effects and impact of finerenone on new-onset AFF in participants with T2D and CKD. The multicentre, double-blinded, phase 3 FIDELIO-DKD trial randomised 5,674 participants to receive either finerenone or a placebo. Of the 5,674 participants, 461 (8.1%) had AFF at baseline, while 5,213 (91.9%) did not. Of the 5,213 participants with no pre-existing AFF, 2,593 (49.7%) received finerenone, and 2,620 (50.3%) participants received a placebo.

The primary endpoint was a composite of kidney failure, a sustained decrease of ≥40% in renal function, or renal death. The key secondary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalisation for heart failure. Both endpoints were analysed by AFF history.

New-onset AFF occurred in 82 (3.2%) patients in the finerenone arm, and 117 (4.5%) patients in the placebo arm, yielding an incidence rate per 100 patient-years of 1.20 and 1.72, respectively, with a hazard ratio of 0.71 (95% CI 0.53–0.94; P=0.0164) and an absolute risk reduction of 1.3%. Prof. Filippatos noted that the following baseline characteristics seemed to have no impact on the protective effects of finerenone: age, sex, kidney characteristics, baseline serum potassium levels, systolic blood pressure, body mass index, glycated haemoglobin (HbA1c), nor use of glucose-lowering therapies. Baseline AFF did not appear to have a statistically significant impact on the effect of finerenone in either primary or secondary endpoints (P for interaction 0.16 and 0.85, respectively) [2].

One of the limitations of this study is that electrocardiograms were performed only once per year, raising the possibility that asymptomatic AFF may have been missed [3].

1. 
   
   1. Fillipatos G. Finerenone And New Onset of Atrial Fibrillation or Flutter in Patients with Chronic Kidney Disease and Type 2 Diabetes. Abstract 411–16, ACC 2021 Scientific Session, 15–17 May.
   2. Fillipatos G, et al. J. Am. Coll. Cardiol. 2021, May 17. DOI: 10.1016/j.jacc.2021.04.079.
   3. Naccarelli GV, et al. J. Am. Coll. Cardiol. 2021, May 17. DOI: 10.1016/j.jacc.2021.04.080.

 

Copyright ©2021 Medicom Medical Publishers



Posted on 9 July 202117 May 2024