Effects of Canagliflozin Versus Finerenone on Cardiorenal Outcomes: Exploratory Post Hoc Analyses From FIDELIO-DKD Compared to Reported CREDENCE Results
Nephrol Dial Transplant 2022;37:1261-9 doi.org/10.1093/ndt/gfab336
This analysis highlights the pitfalls of direct comparisons between trials, since when key differences in design are considered, FIDELIO-DKD and CREDENCE demonstrate similar cardiorenal benefits. The authors conclude that both canagliflozin and finerenone are similarly effective in reducing the risk of cardiorenal outcomes.
At first glance, the results of the FIDELIO-DKD and CREDENCE trials appear disparate: in FIDELIO-DKD, the primary endpoint had an 18% relative risk reduction, but in CREDENCE, this figure was 30%. However – unlike CREDENCE – FIDELIO-DKD included patients with high albuminuria, but excluded those with symptomatic heart failure with reduced ejection fraction (HFrEF). There were also differences in the endpoints selected.
This post hoc exploratory analysis investigated how such differences in trial design influenced the observed treatment effects, based on the data from 4,619 patients from FIDELIO-DKD who met the chronic kidney disease (CKD) inclusion criteria from CREDENCE – a so-called ‘CREDENCE-like’ subgroup. Analysis in this population showed the relative risk of the composite cardiorenal endpoint was significantly reduced by 26% with finerenone versus placebo. The overall numbers of AEs and serious AEs were similar with finerenone versus placebo. These findings suggest that when key trial differences are considered, FIDELIO-DKD and CREDENCE demonstrated cardiorenal benefits of a similar magnitude.