1 Recommendations
1.1 Finerenone is recommended as an option for treating stage 3 and 4 chronic kidney disease (with albuminuria) associated with type 2 diabetes in adults. It is recommended only if:
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it is an add-on to optimised standard care; this should include, unless they are unsuitable, the highest tolerated licensed doses of:
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angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) and
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sodium–glucose cotransporter‑2 (SGLT2) inhibitors and
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the person has an estimated glomerular filtration rate (eGFR) of 25 ml/min/1.73 m2 or more.
1.2 This recommendation is not intended to affect treatment with finerenone that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Why the committee made these recommendations
Standard care for chronic kidney disease in people with type 2 diabetes includes ACE inhibitors and ARBs, with SGLT2 inhibitors being added if needed. Finerenone would be added to ACE inhibitors and ARBs if they are not working well enough. It could be offered before, after, or with SGLT2 inhibitors.
The clinical evidence suggests that finerenone improves kidney function and helps to slow the worsening of the disease compared with placebo (both plus standard care, with and without SGLT2 inhibitors). There are no direct comparisons of finerenone against SGLT2 inhibitors when used as an add-on to standard care (without SGLT2 inhibitors).
The cost-effectiveness estimates are uncertain, but they are all within the range that NICE considers an acceptable use of NHS resources. Because finerenone has not been compared directly with SGLT2 inhibitors as an add-on to standard care (without SGLT2 inhibitors), it cannot be recommended instead of them. So, finerenone is recommended as an add-on to standard care, when standard care includes SGLT2 inhibitors.