非奈利酮降糖效果好吗?

What are the effects of fenelinone?

Fenelidone is generally effective in treating diabetes, but it can only achieve an auxiliary improvement effect. The approved indication is to reduce the risk of hospitalization for persistent eGFR (epidermal factor growth receptor) decline, end-stage renal disease, cardiovascular death, non-fatal myocardial infarction and heart failure in adult patients with chronic kidney disease (CKD) associated with type 2 diabetes (T2D). Fenelidone belongs to a class of drugs called mineralocorticoid receptor (MR) antagonists, which work by blocking the activity of certain steroids made in the body that can damage the heart and kidneys.

Trial effects of fenelidone in patients with type 2 diabetes

Fennelidone has favorable effects on cardiorenal outcomes in patients with predominantly stage 3 or 4 chronic kidney disease (CKD) with severely elevated albuminuria and type 2 diabetes. In a double-blind trial (NCT02545049), patients with CKD and type 2 diabetes were randomly assigned to receive fenelidone or placebo. Eligible patients had a urine albumin to creatinine ratio (albumin in milligrams and creatinine in grams) of 30 to less than 300 and an estimated glomerular filtration rate (eGFR) of 25 to 90 ml per minute/1.73 m2 of body surface area (stages 2-4 CKD) or a urine albumin/creatinine ratio of 300-5000 and an eGFR of at least 60 ml/minute 1.73 ㎡ (CKD Phase 1 or 2).

Trial results: A total of 7437 patients underwent randomization. Among the patients included in the analysis, during a median follow-up of 3.4 years, the primary outcome event occurred in 458 of 3686 patients (12.4%) in the fenelidone group and in 519 of 3666 patients (14.2%) in the placebo group (hazard ratio, 0.87). The benefit was mainly due to a reduction in the rate of heart failure hospitalization (hazard ratio, 0.71). The secondary composite outcome occurred in 350 patients (9.5%) in the fenelidone group and 395 patients (10.8%) in the placebo group (hazard ratio, 0.87). The overall frequency of adverse events did not differ substantially between groups. Hyperkalemia-related protocol discontinuations occurred more frequently in the fenelidone group (1.2%) than in the placebo group (0.4%).

Conclusions: Treatment with fenelidone improved cardiovascular outcomes compared with placebo in patients with type 2 diabetes and stage 2-4 CKD with moderately elevated albuminuria or stage 1 or 2 CKD with severely elevated albuminuria. It is recommended that patients take medication under the guidance of a doctor and receive symptomatic treatment.

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References

Pitt B, Filippatos G, Agarwal R, Anker SD, Bakris GL, Rossing P, Joseph A, Kolkhof P, Nowack C, Schloemer P, Ruilope LM; FIGARO-DKD Investigators. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med. 2021 Dec 9;385(24):2252-2263. doi: 10.1056/NEJMoa2110956. Epub 2021 Aug 28. PMID: 34449181.