Finerenone may lower risks for pneumonia, COVID-19 in adults with type 2 diabetes and CKD
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Adults with type 2 diabetes and chronic kidney disease using the nonsteroidal mineralocorticoid receptor antagonist finerenone have lower risks for pneumonia and COVID-19, according to findings published in JAMA Network Open.
In a secondary analysis of FIDELITY, a pooled analysis of the FIDELIO-DKD and FIGARO-DKD trials, adults with type 2 diabetes and CKD randomly assigned to finerenone (Kerendia, Bayer) had lower incidences of pneumonia and COVID-19 adverse events compared with adults randomly assigned to placebo.
“Pneumonia was the most commonly reported serious adverse event in FIDELITY, highlighting that pneumonia is a significant source of morbidity in the CKD and type 2 diabetes population, as reported previously,” Bertram Pitt, MD, professor of medicine emeritus at the University of Michigan School of Medicine, and colleagues wrote. “Although no between-group differences were observed in other associated respiratory infections, the striking reduction in risk of pneumonia observed in both independent studies might suggest that the propagation of pulmonary infection into lobar or bronchial consolidation may be reduced by finerenone.”
Researchers analyzed individual patient-level data from the FIDELIO-DKD and FIGARO-DKD trials, where adults with type 2 diabetes and CKD were randomly assigned to 10 mg or 20 mg finerenone daily or placebo. As Healio previously reported, finerenone reduced the risk for cardiovascular death and delayed the progression of CKD in the trials. In the secondary analysis, investigator-reported incidences of pneumonia adverse events and serious adverse events up to 3 days after treatment, and any COVID-19 adverse events were collected.
FIDELITY included 13,026 adults (mean age, 64.8 years; 69.8% men) with a median follow-up of 3 years. The group of participants who had a pneumonia adverse event had a higher prevalence of chronic obstructive pulmonary disease, asthma, CV disease, coronary artery disease and obesity at baseline than those who did not have pneumonia, and the group of adults who had COVID-19 had a higher proportion with obesity than those who did not have COVID-19.
During a median of 2.6 years, adults randomly assigned to finerenone had a lower risk for treatment-emergent pneumonia compared with placebo (HR = 0.71; 95% CI, 0.64-0.79; P < .001). There were no differences in rates of nasopharyngitis, bronchitis and influenza between the finerenone and placebo groups. The maximum intensity of pneumonia adverse events was moderate for both the treatment and placebo groups.
Pneumonia was the most common serious adverse event reported in the trials. Adults receiving finerenone had a lower risk for a pneumonia serious adverse event than those receiving placebo (HR = 0.69; 95% CI, 0.6-0.79; P < .001).
COVID-19 adverse events were reported beginning in January 2020. Adults randomly assigned to finerenone had a lower risk for COVID-19 compared with those randomly assigned to placebo (HR = 0.73; 95% CI, 0.6-0.89; P = .002). The percentage of participants experiencing mild, moderate or severe COVID-19 was similar in the two groups.
“The findings of this secondary analysis suggest that mineralocorticoid receptor blockade with finerenone was associated with protection against pneumonia and COVID-19 adverse events in patients with type 2 diabetes and CKD,” the researchers wrote. “Further research into elucidating if mineralocorticoid receptor blockade reduces pneumonia- and COVID-19-related complications in other patient groups would have significant medical implications, especially considering the limited treatment options for COVID-19 complications.”
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