Finerenone plus SGLT2 inhibitor reduces albuminuria more than either drug alone
Concurrent use of finerenone and empagliflozin reduced urine albumin-to-creatinine ratio for adults with CKD and type 2 diabetes. Albuminuria reduction was greater than for either agent used separately. Adults with chronic kidney disease and type 2 diabetes had slower kidney function decline with a combination of the nonsteroidal mineralocorticoid receptor antagonist finerenone and empagliflozin vs. either alone, according to study data.
In addition, researchers observed no clinically significant increased risks for adverse events with the combination therapy. Data from the CONFIDENCE trial were presented at the ERA Congress (62nd European Renal Association Congress, Vienna, June 4-7, 2025) and simultaneously published in The New England Journal of Medicine.
“Simultaneous initiation of finerenone and an SGLT2 inhibitor provides early and additive effects on urine albumin-to-creatinine ratio reduction that are statistically and clinically significant,” Hiddo J. L. Heerspink, PhD, professor and clinical pharmacologist in the department of clinical pharmacy and pharmacology at the University Medical Center Groningen in the Netherlands, told Healio. “The combination is safe, and drug discontinuation due to hypotension, acute kidney injury and hyperkalemia was uncommon.”
At 180 days, the combination therapy group had a 29% greater reduction in UACR from baseline than the finerenone group (least-squares mean ratio of difference in change from baseline = 0.71; 95% CI, 0.61-0.82) and a 32% greater reduction than the empagliflozin group (least-squares mean ratio of difference in change from baseline = 0.68; 95% CI, 0.59-0.79).
“Fifty-four percent of the patients who received the combination therapy had 30% reduction in albuminuria at 14 days,” Rajiv Agarwal, MD, MS, professor emeritus of medicine at Indiana University School of Medicine and a staff physician at the VA Medical Center in Indianapolis, told Healio. “This early reduction of UACR was unexpected.”
Less than 5% of participants in each group dropped out of the trial due to adverse events. Rates of adverse events and serious adverse events were similar across groups, according to the researchers.
“The strategy of simultaneous start of finerenone and empagliflozin might get more patients to goal levels of albuminuria reduction compared to monotherapy without increasing the risk of clinically significant adverse events,” Agarwal said.
Heerspink said future studies should evaluate clinical outcomes with longer-term use of finerenone plus an SGLT2 inhibitor.
