Pharmacy Times: What did your SOLSTICE analysis show about elecoglipron and albuminuria in type 2 diabetes?
Hiddo J. L. Heerspink, PharmD, PhD: The SOLSTICE trial showed that the oral GLP-1 RA elecoglipron at doses ranging between 5 mg and 75 mg once daily reduced UACR compared to placebo. Elecoglipron 50 mg daily resulted in a similar reduction in UACR compared to semaglutide (Wegovy, Ozempic; Novo) 14 mg daily, and the 75 mg dose showed a nominally larger UACR reduction. In these patients, elecoglipron also reduced HbA1c up to 1.9% at the highest dose and reduced body weight by approximately 8%—[along with reductions] in high-sensitivity C-reactive protein. These data supported the design of a phase 3 clinical trial (ELEVATE-CKD), which is currently ongoing.
Pharmacy Times: Why does glucagon’s role in the kidney matter as multihormone therapies advance?
Key Takeaways
- Elecoglipron shows an early albuminuria signal.
- Finerenone may help preserve kidney function in FSGS.
- Combination therapy is the future of CKD care.
Heerspink: Glucagon plays an important role in the kidney, as it reduces peri-renal and sinus fat volume, improves metabolic markers, including insulin, HbA1c, and leptin, increases adiponectin, improves glomerular hemodynamics (as shown by a reduction in intraglomerular pressure and renal arterial resistance index, a measure of vascular resistance and arterial stiffness), and reduces pro-fibrotic signalling. Collectively, these effects result in a reduction in albuminuria and potentially [an increase] in long-term kidney protection.
Pharmacy Times: What could finerenone offer patients with FSGS, and what questions remain?
Heerspink: Finerenone reduces eGFR decline in patients with FSGS compared to placebo by 1.3 ml/min/1.73 m2 and reduces the risk of clinical kidney end points by 40% (although this effect was not statistically significant (P = .06) likely due to the relatively small sample size). Finerneone also reduces proteinuria by 40%. These data provide evidence that finerenone is an effective therapy to preserve kidney function in patients with FSGS.
Pharmacy Times: How should pharmacists think about combining these therapies for patients with CKD?
Heerspink: In the future, many patients with CKD will be treated with a combination of treatments. It is important for pharmacists to be aware of these combination treatments and to know that there are few drug-drug interactions so that these drugs can be safely and efficiently combined.
