Combining a sodium-glucose cotransporter-2 (SGLT2) inhibitor and mineralocorticoid receptor antagonist (MRA) may further reduce albuminuria compared with monotherapy in patients with diabetic nephropathy, investigators reported at the National Kidney Foundation’s 2023 Spring Clinical Meetings in Austin, Texas.1
Investigators conducted a network meta-analysis of 17 studies including 34,412 patients with type 2 diabetes and a urinary albumin to creatinine ratio (UACR) of 30 mg/g or higher. Findings from the meta-analysis were published online in Diabetes, Obesity and Metabolism in February.2
Treatment with SGLT2 inhibitors or MRAs alone significantly reduced UACR by a mean difference of -31.03 and -32.97, respectively, compared with placebo. MRAs and SGLT2 inhibitors offered similar protection against albuminuria, the investigators noted.
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The combination treatment was significantly associated with further reduction in albuminuria: -34.19, -32.25, and -65.22 compared with SGLT2 inhibitors alone, MRAs alone, or placebo, respectively, Ryutaro Morita, MD, of Yokohama City University Graduate School of Medicine in Yokohama, Japan, and colleagues reported.
Study findings also revealed that the combination treatment was significantly associated with greater reduction in systolic blood pressure compared with SGLT2 inhibitors alone, MRAs alone, and placebo: -5.80, -5.90, and -9.13 mmHg, respectively. Most patients were taking background renin angiotensin system inhibitors. Estimated glomerular filtration rate at baseline was at least 25 mL/min/1.73 m2.
Reduction in albuminuria may reduce the risk of end-stage kidney disease and cardiovascular diseases, Dr Morita’s team noted in their journal article. Therefore, minimizing albuminuria in patients with diabetes is “imperative.”
“Because of the different mechanisms of action of SGLT2-Is and MRAs, we expect synergistic effects of the combination of SGLT2-Is and MRAs,” the authors wrote.
Reference
Morita R, Tsukamoto S, Obata S, Yamada T, Rehman M. The effect of sodium-glucose cotransporter 2 inhibitors, mineralocorticoid receptor antagonists, and its combination on albuminuria in patients with diabetic nephropathy. Presented at: National Kidney Foundation 2023 Spring Clinical Meetings, Austin, Texas, April 11-15. Abstract 280.
Morita R, Tsukamoto S, Obata S, et al. Effects of sodium-glucose cotransporter 2 inhibitors, mineralocorticoid receptor antagonists, and their combination on albuminuria in diabetic patients. Diabetes Obes Metab. Published online February 2, 2023. 25(5):1271-1279. doi:10.1111/dom.14976
