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Breakthrough drug advances offer promise of improved DKD therapeutic options


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3 minutes

George Bakris, MD
George Bakris, MD

Emerging data have provided promising evidence of the benefits of newer drug classes in slowing—perhaps even arresting—the progression of diabetic kidney disease (DKD).

A panel of researchers will review the latest advances in DKD drug development and research during the session Breakthrough! Effective Treatments for Diabetic Kidney Disease, which will be held at 4:30 p.m. CT Monday, June 6, in La Nouvelle Orleans Ballroom C at the convention center. The session will also be livestreamed for virtual meeting attendees.

“For some time, we really only had the ACE (angiotensin-converting enzyme) inhibitors and angiotensin receptor blockers (ARBs) to treat our patients with DKD,” said George Bakris, MD, University of Chicago Medicine. “In addition to those classes of agents, we now have the SGLT2 (sodium-glucose cotransporter-2) inhibitors and, even more recent, the nonsteroidal mineralocorticoid receptor antagonists (MRAs). And, probably within the next year or so if things go well, we will also have the GLP-1 (glucagon-like peptide-1) receptor agonists. So, potentially by 2024, we will have four classes of agents we can use to slow the progression of kidney disease.”

Dr. Bakris will discuss findings from the FIDELITY study, a pooled analysis of data from the FIDELIO-DKD and FIGARO-DKD studies of patients with type 2 diabetes and chronic kidney disease (CKD). The purpose of the FIDELITY analysis was to further evaluate the safety and efficacy of finerenone, a novel selective nonsteroidal MRA.

“What’s unique about these new classes of drugs is that they’re not glucose-lowering drugs. They’re cardio-renal risk-reducing agents that happen to lower glucose if your kidney function is normal or reasonable,” Dr. Bakris said. “The nonsteroidal MRAs, for example, have no effects on sugar and have even less effect on blood pressure, if well-controlled, than do the SGLT2s. And yet, they’re slowing progression of diabetic kidney disease.”

Daniël van Raalte, MD, PhD
Daniël van Raalte, MD, PhD

In the FIDELITY analysis, which looked at more than 13,000 patients with documented DKD and high cardiovascular risk, finerenone therapy resulted in a 22% risk reduction for heart failure hospitalization and a 20% reduction in people going on to dialysis, Dr. Bakris said.

“And what’s really interesting is that this was independent of SGLT2 inhibitor use. So I would argue that if you added an SGLT2 inhibitor, you’d probably easily add 10% to 20% further benefit on slowing CKD progression,” he said.

While the mechanisms of SGLT2 inhibitors, nonsteroidal MRAs, and GLP-1 receptor agonists in impacting DKD progression are not yet fully understood, there are a growing number of studies suggesting that the use of these agents in combination may reduce morbidity in a very substantive way, said Daniël van Raalte, MD, PhD, Amsterdam UMC, who will review data on DKD combination therapy.

“We have strong trial data on a number of drugs that do slow down kidney disease and can potentially reduce the heavy burden of kidney complications in people living with diabetes,” Dr. van Raalte said. “With these newer treatment options becoming available, the questions we need to further explore include what sequence we should start the drugs, whether they all can be safely combined, and whether they maintain their efficacy when used in combination. I hope this session will help clinicians better understand how to treat diabetic kidney disease, and how to integrate different treatment options for their patients.”

Also during the session, Janani Rangaswami, MD, FACP, Einstein Medical Center, will discuss new data on the effects and clinical application of SGLT2 inhibitors, and Peter Rossing, MD, DMSc, Steno Diabetes Center Copenhagen, will review a new joint statement from the ADA and KDIGO (Kidney Disease: Improving Global Outcomes) on the management of diabetes and CKD.