According to a recent report in Healio News, the GLP-1 agonists are medications developed primarily to control blood sugar levels for type two diabetes.
About the FLOW Clinical Trial
The FLOW clinical trial investigated semaglutide which is primarily used in the treatment of type two diabetes. Results were announced at the European Renal Association Congress and later published in the New England Journal of Medicine. Individuals participating in the trial who were assigned to semaglutide exhibited less risk for severe kidney disease or cardiovascular events than people assigned to placebo. Professor Matthew Weir, nephrology division chief at Maryland University, commented that semaglutide may become a critical tool for physicians who treat type two diabetes and chronic kidney disease (CKD).
Today’s CKD medications do not have the range of benefits available through GLP-1. The data shows that semaglutide may eventually be a medication with the benefit of slowing CKD progression. During the past five years, several SGLT2 inhibitors have received FDA approval. A receptor antagonist named finerenone was approved in 2021. It lowers the risk of cardiovascular (CV) and renal complications for type two diabetes patients.
For the next 20 years after two therapies were approved, namely angiotensin converting enzyme and receptor blocker, there were no other approved therapies to lower the risk of CKD. Yet, in order for semaglutide or other treatments to be effective, patients must be carefully screened for CKD.
Many studies have shown that the creatine to urinary albumin ratio (UACR) has not been measured annually. As a further reminder, it is a critical marker for people with CKD or those at risk for the disorder.
Erin Michos, MD., a Johns Hopkins professor of medicine told Healio that due to the prevalence of CKD in patients who have diabetes and hypertension, she measures all her patients’ eGFR as well as the UACR. Dr Michos explained that you do not know who will receive the benefit from the therapies until CKD is identified.
About FLOW Findings
Approximately 3,533 adult patients with type two diabetes were enrolled in the FLOW trial. These patients are also at high-risk for CKD on a stable renin-angiotensin system (RAS) inhibitor therapy.
RAS means long-term and consistent reliance on medication that blocks RAS thus managing long-term utilization of the RAS to stabilize conditions such as high blood pressure or heart failure.
RAS references consistent use of medicine that blocks the RAS system such as the use of DRAS medications.
RAS: The System
RAS inhibitor therapy relies on long-term and consistent use of medications that block the RAS system. Stable dosage of medication must be in place during a certain time frame so that therapeutic benefits are maintained without fluctuations, specifically blood pressure fluctuations. Trial participants randomly received a once-a-week 1 mg semaglutide or placebo. In one trial outcome eGFR was reduced by 50% from the baseline or CV or from kidney associated mortality.
At the three-to-four-year follow-up, semaglutide patients saw a lower risk of kidney disease as opposed to participants assigned placebo. Semaglutide was reported to be associated with less risk for severe CV adverse events as well as mortality from any cause when compared to placebo. In the final analysis the results of the FLOW trial exhibited 24% less kidney disease risk and 18% less risk of CV events.
A sub analysis of the SELECT clinical trial, investigating overweight adults, plus CVE but absent diabetes, evidenced a lower risk of 22% for patients receiving similitude 2.4 mg. vs placebo. Dr. Pratley repeated his cautionary advice that everyone with diabetes should receive screening each year for eGFR and urine albumin-to-creatine ratio.
