Circulation:Finerenone降低慢性肾病和2型糖尿病患者心衰风险

2021-11-16 MedSci原创 MedSci原创

这些FIGARO-DKD分析的结果表明,无论是否伴有HF病史,Finerenone都能减少CKD和T2D患者的新发HF并改善其他HF结局。

慢性肾病(CKD)和2型糖尿病(T2D)与心力衰竭(HF)独立相关,心力衰竭是患者发病率和死亡率的主要原因。在FIDELIO-DKD和FIGARODKD试验中,Finerenone(一种选择性非甾体盐皮质激素受体拮抗剂)改善了白蛋白尿性CKD和T2D患者的心血管结局。

近日,心血管领域权威杂志Circulation上发表了一篇研究文章,这些来自FIGARO-DKD的预设分析评估了Finerenone对临床上重要的HF结局的影响。T2D和白蛋白尿性CKD患者(尿白蛋白肌酐比[UACR]≥30至<300mg/g,且估计肾小球滤过率[eGFR]≥25至≤90ml/min/1.73m2,或UACR≥300至≤5000mg/g和eGFR≥60ml/min/1.73m2),无射血分数降低的症状性心衰,随机分配至Finerenone或安慰剂。

首次事件结局包括:新发HF(基线时无HF病史的患者首次因HF住院[HHF]);心血管死亡或首次HHF;HF相关死亡或首次HHF;首次HHF;心血管死亡或全部(首次或复发)HHF;HF相关死亡或总HHF;以及总HHF。在总体人群和按基线HF病史分类的预先指定的亚组中评估结局。

该研究总共有7352名患者被纳入分析;571名(7.8%)患者在基线时有HF病史。与安慰剂相比,Finerenone显著降低了新发HF(1.9% vs. 2.8%;风险比[HR]为0.68[95%CI为0.50-0.93];P=0.0162)。在总体人群中,Finerenone相比于安慰剂治疗所有HF结局的发生率显著降低,包括心血管死亡或首次HHF的风险降低18%(HR为0.82[95%CI为0.70-0.95];P=0.011),首次发生HHF的风险降低29%(HR为0.71[95%CI为0.56-0.90];P=0.0043),总HHF发生率降低30%(比率为0.70[95%CI为0.52-0.94])。Finerenone对改善HF结局的影响不会因HF病史而改变。治疗组之间的治疗突发不良事件的发生率类似。

由此可见,这些FIGARO-DKD分析的结果表明,无论是否伴有HF病史,Finerenone都能减少CKD和T2D患者的新发HF并改善其他HF结局。

原始出处:

Gerasimos Filippatos,et al.Finerenone Reduces Risk of Incident Heart Failure in Patients With Chronic Kidney Disease and Type 2 Diabetes: Analyses from the FIGARO-DKD Trial.Circulation. 2021.https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057983

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