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Estimated lifetime benefit of novel pharmacological therapies in patients with type 2 diabetes and chronic kidney disease: A joint analysis of randomized controlled clinical trials.
- Source :
-
Diabetes, obesity & metabolism [Diabetes Obes Metab] 2023 Nov; Vol. 25 (11), pp. 3327-3336. Date of Electronic Publication: 2023 Aug 14. - Publication Year :
- 2023
-
Abstract
- Aim: To estimate the lifetime benefit of a combination treatment of sodium-glucose co-transporter 2 (SGLT2) inhibitors and mineralocorticoid-receptor antagonists (MRA) in patients with type 2 diabetes and chronic kidney disease (CKD).<br />Materials and Methods: The cumulative effect of combination treatment was derived from trial-level estimates of the effect of an SGLT2 inhibitor (canagliflozin) and MRA (finerenone) from the CREDENCE (N = 4401) and FIDELIO (N = 5734) trials, respectively. The cumulative effect was applied to the control group of patients with type 2 diabetes in the DAPA-CKD trial (N = 1451) to estimate long-term gains in event-free and overall survival. The analysis was repeated in an observational study. The primary outcome was a composite endpoint of doubling of serum creatinine, end-stage kidney disease or death because of kidney failure.<br />Results: The hazard ratio of combination treatment for the primary outcome was 0.50 [95% confidence interval (CI): 0.44, 0.57]. At age 50 years, the estimated event-free survival from the primary outcome was 16.7 years (95% CI: 18.1, 21.0) with combination treatment versus 10.0 years (95% CI: 6.8, 12.3) with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers resulting in an incremental gain of 6.7 years (95% CI: 5.5, 7.9). In an observational study, the estimated gain in event-free survival regarding primary outcome was 6.3 years (95% CI: 5.2, 7.3). In a conservative scenario, assuming low adherence (70% of the observed adherence) and less pronounced efficacy (70% of the observed efficacy with 2% yearly decline) of combination therapy, gain in event-free survival regarding primary outcome was 2.5 years (95% CI: 2.0, 2.9).<br />Conclusions: Combined disease-modifying treatment with an SGLT2 inhibitor and MRA in patients with type 2 diabetes and CKD may substantially increase the number of years free from kidney failure and mortality.<br /> (© 2023 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)
- Subjects :
- Humans
Middle Aged
Canagliflozin therapeutic use
Mineralocorticoid Receptor Antagonists therapeutic use
Diabetes Mellitus, Type 2 complications
Diabetes Mellitus, Type 2 drug therapy
Diabetes Mellitus, Type 2 chemically induced
Sodium-Glucose Transporter 2 Inhibitors therapeutic use
Renal Insufficiency, Chronic complications
Renal Insufficiency, Chronic drug therapy
Renal Insufficiency, Chronic epidemiology
Kidney Failure, Chronic complications
Kidney Failure, Chronic epidemiology
Kidney Failure, Chronic prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1463-1326
- Volume :
- 25
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Diabetes, obesity & metabolism
- Publication Type :
- Academic Journal
- Accession number :
- 37580309
- Full Text :
- https://doi.org/10.1111/dom.15232