Efficacy and safety of finerenone with SGLT2i in IgA nephropathy

Abstract Purpose This study aimed to compare the renal protective effects and safety profile of finerenone plus sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapy versus monotherapy in patients with IgA nephropathy. Methods The retrospective study evaluated 76 patients with biopsy-proven IgA nephropathy at the First Affiliated Hospital of Zhengzhou University (2023–2024). Participants were divided into three groups: finerenone plus SGLT2i group (n = 26), finerenone monotherapy group (n = 32), and SGLT2i monotherapy group (n = 18). Changes in urinary protein-to-creatinine ratio (UPCR) and estimated glomerular filtration rate (eGFR) at 3 and 6 months were evaluated. Safety assessments focused on hyperkalemia incidence and treatment-emergent adverse events. Results The combination therapy demonstrated superior proteinuria reduction compared to monotherapies, with median UPCR reductions of 40.89% at Month 3 and 54.62% at Month 6 versus 23.72%/30.88% (finerenone) and 24.69%/24.69% (SGLT2i) (all P < 0.05). Significantly more patients achieved ≥ 50% UPCR reduction in finerenone plus SGLT2i group at Month 6 (53.8% vs 25.0% and 22.2%, P = 0.033). Logistic regression analysis demonstrated adjusted odds ratios ranging from 3.87 to 18.90 for finerenone plus SGLT2i therapy achieving ≥ 50% proteinuria reduction (all P < 0.05). Renal function parameters remained stable in all treatment groups without significant intergroup differences (all P > 0.05). The safety profile showed comparable hyperkalemia incidence rates between groups (P = 0.332). No severe adverse events or treatment withdrawals attributable to hyperkalemia were observed. Conclusion Our study shows that combined finerenone-SGLT2i therapy has a more rapid and superior proteinuria reduction versus monotherapy in IgA nephropathy, with preserved renal function and good safety.