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Do you plan to initiate combination therapy with an SGLT-2 inhibitor and finerenone, instead of an SGLT-2 inhibitor alone, when treating patients with proteinuric chronic kidney disease and type 2 diabetes in light of the CONFIDENCE trial findings?

Agarwal et al., PMID 40470996
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Do you plan to initiate combination therapy with an SGLT-2 inhibitor and finerenone, instead of an SGLT-2 inhibitor alone, when treating patients with proteinuric chronic kidney disease and type 2 diabetes in light of the CONFIDENCE trial findings?

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3 Answers
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Nephrology · Penn Medicine Cherry Hill
Answered on

I would start one (typically the SGLT-2 inhibitor), then add finerenone potentially later. If both are started simultaneously and there is an AE, then both may have to be stopped. I prefer to see that one is tolerated, then start another.

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Nephrology · University Of California San Francisco Medical Center At Parnassus
Answered on

No. I would go step by step and evaluate the response. First blood pressure control, then ACE/ARB, then SGLT-2, and finally finerenone. At each step, I would evaluate the effect on proteinuria, and if I achieve a significant reduction and the goal level, I would consider whether the next step is nec...

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Nephrology · Premier Nephrology Medical Group
Answered on

I don’t see anyone commenting on why the CONFIDENCE trial from NEJM earlier this month is not strong enough data to change our practice?

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