Can Kerendia (finerenone) and Farxiga (dapagliflozin) be used together?

Using Kerendia (Finerenone) and Farxiga (Dapagliflozin) Together

Yes, Kerendia (finerenone) and Farxiga (dapagliflozin) can be used together, and this combination may provide additive benefits for patients with type 2 diabetes and chronic kidney disease. Recent evidence supports the combined use of these medications for improved cardiovascular and renal outcomes.

Mechanism and Benefits of Combination Therapy

• Finerenone is a nonsteroidal mineralocorticoid receptor antagonist that reduces inflammation and fibrosis in the kidney and heart 1
• Dapagliflozin is a sodium-glucose cotransporter-2 (SGLT2) inhibitor that reduces renal glucose reabsorption, leading to increased urinary glucose excretion and reduced blood glucose levels 2
• The combination of these medications works through complementary mechanisms to address different pathways in kidney disease progression 3

Evidence Supporting Combined Use

• The CONFIDENCE trial demonstrated that simultaneous initiation of finerenone and an SGLT2 inhibitor (empagliflozin) led to a 29% greater reduction in urinary albumin-to-creatinine ratio compared to finerenone alone and a 32% greater reduction compared to the SGLT2 inhibitor alone 3
• This combination therapy showed consistent benefits across all KDIGO risk categories (low/moderate, high, and very high risk) for kidney disease 4
• The safety profile of the combination was acceptable with no unexpected adverse events when both medications were used together 3, 4

Clinical Recommendations for Combined Use

• For patients with type 2 diabetes and chronic kidney disease with albuminuria already treated with maximum tolerated doses of ACE inhibitors or ARBs, adding finerenone is recommended to improve cardiovascular outcomes and reduce CKD progression 5
• In the same population, SGLT2 inhibitors like dapagliflozin are recommended to reduce risk of CKD progression and cardiovascular events 5
• Current guidelines suggest that in people with type 2 diabetes and established atherosclerotic cardiovascular disease or multiple risk factors, combined therapy with an SGLT2 inhibitor and other agents with demonstrated cardiovascular benefit may be considered for additive reduction in cardiovascular and kidney events 5

Monitoring and Precautions

• Monitor serum potassium levels closely, as both medications can affect potassium balance, with finerenone having a higher risk of hyperkalemia 5, 1
• Check renal function regularly, particularly when initiating therapy 5
• The combination is most appropriate for patients with eGFR ≥20 mL/min/1.73 m² and UACR ≥200 mg/g creatinine 5
• Avoid triple therapy with ACE inhibitors and ARBs together with these medications, as this combination increases risk of adverse events 5

Patient Selection

• Best candidates are those with type 2 diabetes and CKD with albuminuria (UACR ≥100 mg/g) 3, 4
• Patients should already be on a renin-angiotensin system inhibitor (ACE inhibitor or ARB) 5
• The combination may be particularly beneficial for patients at high risk for CKD progression or cardiovascular events 4

This combination represents an important advancement in the management of patients with type 2 diabetes and chronic kidney disease, targeting multiple pathways involved in disease progression for improved outcomes.