Indirect comparison of finerenone and SGLT 2 inhibitors in established chronic kidney disease: evidence based on Bayesian methods

Abstract

Abstract Background Head-to-head comparison of finerenone and SGLT2 inhibitors in patients with established chronic kidney disease (CKD) remains absent. Methods and results All dedicated CKD trials about finerenone versus placebo or SGLT2 inhibitors versus placebo were searched. A Bayesian approach to network meta-analysis was applied. In patients with CKD, no significant difference in the composite of renal outcomes (OR 1.14, 95% CI 0.92–1.88), the composite of cardiovascular death or hospitalization for heart failure (OR 0.94, 95% CI 0.58–1.56), all-cause mortality (OR 1.04, 95% CI 0.78–1.43), and cardiovascular death (OR 0.99, 95% CI 0.73–1.35) was observed between finerenone and SGLT2 inhibitors. In patients with type 2 diabetes and CKD, no significant difference in the composite of renal outcomes (OR 0.97, 95% CI 0.50–1.69), the composite of cardiovascular death or hospitalization for heart failure (OR 0.86, 95% CI 0.48–1.62), all-cause mortality (OR 0.97, 95% CI 0.74–1.28), and cardiovascular death (OR 0.95, 95% CI 0.65–1.38) was observed between finerenone and SGLT2 inhibitors. We ranked the risk of the major outcomes in patients with CKD. As a result, dapagliflozin was identified as having the lowest risk of renal outcomes and all-cause mortality, while canagliflozin was identified as having the lowest risk of cardiovascular outcomes. Conclusions In patients with CKD, there was no significant difference in the major outcomes between finerenone and SGLT2 inhibitors; however, dapagliflozin and canagliflozin may be associated with the lowest risk of the major outcomes.