Outcomes With Finerenone by Baseline Treatment Goals in Type 2 Diabetes and Chronic Kidney Disease: A <scp>FIDELITY</scp> Analysis

AIMS: The American Diabetes Association recommends achieving treatment goals (glycated haemoglobin ≤ 53 mmol/mol [7.0%], blood pressure < 130/80 mmHg, low-density lipoprotein cholesterol < 1.81 mmol/L and use of sodium-glucose cotransporter-2 inhibitors or glucagon-like peptide-1 receptor agonists), to reduce cardiovascular and kidney complications in people with chronic kidney disease and type 2 diabetes. This exploratory study assessed whether treatment effects of finerenone versus placebo were modified by the number of treatment goals met at baseline. MATERIALS AND METHODS: FIDELITY, a prespecified pooled analysis, combined participant-level data from the randomized, double-blind, multicentre phase III FIDELIO-DKD (NCT02540993) and FIGARO-DKD (NCT02545049) trials. Participants with type 2 diabetes and chronic kidney disease were randomized 1:1 to finerenone or placebo. Composite cardiovascular and kidney outcomes, hospitalization for heart failure or cardiovascular death, hospitalization for heart failure and treatment-emergent adverse events were assessed by subgroups based on the number of treatment goals achieved. RESULTS: At baseline, 29%, 40%, 24% and 7% of participants had met 0, 1, 2 and ≥ 3 treatment goals, respectively. Those with more treatment goals met had fewer composite cardiovascular outcomes (events per 100 patient-years in the placebo group: 6.0, 5.1, 4.3 and 3.5 for 0, 1, 2 and ≥ 3 treatment goals, respectively). Similar patterns were observed for other outcomes. There was no heterogeneity in the effect of finerenone versus placebo on outcomes between subgroups. The safety profile of finerenone (vs. placebo) was similar across subgroups. CONCLUSIONS: Finerenone demonstrated treatment benefits in people with chronic kidney disease and type 2 diabetes, irrespective of treatment goals achieved at baseline.