Rationale and design of a randomised phase III registration trial investigating finerenone in participants with type 1 diabetes and chronic kidney disease: The FINE-ONE trial

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  • Hiddo J.L. Heerspink
  • Andreas L. Birkenfeld
  • David Z.I. Cherney
  • Helen M. Colhoun
  • Linong Ji
  • Chantal Mathieu
  • Per Henrik Groop
  • Richard E. Pratley
  • Sylvia E. Rosas
  • Rossing, Peter
  • Jay S. Skyler
  • Katherine R. Tuttle
  • Robert Lawatscheck
  • Charlie Scott
  • Robert Edfors
  • Markus F. Scheerer
  • Peter Kolkhof
  • Janet B. McGill

Aims: Despite guideline-recommended treatments, including renin angiotensin system inhibition, up to 40 % of individuals with type 1 diabetes develop chronic kidney disease (CKD) putting them at risk of kidney failure. Finerenone is approved to reduce the risk of kidney failure in individuals with type 2 diabetes. We postulate that finerenone will demonstrate benefits on kidney outcomes in people with type 1 diabetes. Methods: FINE-ONE (NCT05901831) is a randomised, placebo-controlled, double-blind phase III trial of 7.5 months’ duration in ∼220 adults with type 1 diabetes, urine albumin/creatinine ratio (UACR) of ≥ 200–< 5000 mg/g (≥ 22.6–< 565 mg/mmol) and eGFR of ≥ 25–< 90 ml/min/1.73 m2. Results: The primary endpoint is relative change in UACR from baseline over 6 months. UACR is used as a bridging biomarker (BB), since the treatment effect of finerenone on UACR was associated with its efficacy on kidney outcomes in the type 2 diabetes trials. Based on regulatory authority feedback, UACR can be used as a BB for kidney outcomes to support registration of finerenone in type 1 diabetes, provided necessary criteria are met. Secondary outcomes include incidences of treatment-emergent adverse events, treatment-emergent serious adverse events and hyperkalaemia. Conclusions: FINE-ONE will evaluate the efficacy and safety of finerenone in type 1 diabetes and CKD. Finerenone could become the first registered treatment for CKD associated with type 1 diabetes in almost 30 years. Trial registration: ClinicalTrials.gov NCT05901831.

Original languageEnglish
Article number110908
JournalDiabetes Research and Clinical Practice
Volume204
Number of pages17
ISSN0168-8227
DOIs
Publication statusPublished - 2023

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© 2023 The Authors

    Research areas

  • Albuminuria, Chronic kidney disease, Finerenone, Type 1 diabetes

ID: 375967972