FLOW got published and nobody in here is talking about eGFR slope
FLOW (Perkovic et al., N Engl J Med , 2024) reported a hazard ratio of 0.76 for the composite kidney endpoint in people with type 2 diabetes and chronic kidney disease. The front page spent a week on a weight-loss thread. The part I want to argue about is the eGFR slope. A slower rate of decline is not a headline…
Agreed, and the reason slope gets ignored is that it does not fit the format everybody uses to discuss these drugs. A hazard ratio is a single quotable number. A slope is a rate, and a rate needs a timeframe to mean anything.
Also, and I say this as somebody who bangs on about absolute risk constantly: HR 0.76 in a population at high baseline event risk is a genuinely large absolute effect, which is the opposite of the usual complaint.
yes — this is one of the trials where the relative number understates rather than overstates, because the baseline risk is so high.
which makes it one of the few readouts where I do not have to demand the number needed to treat, because it is small enough to be obviously worth it.
and the confidence interval is narrow, which for a composite endpoint in a CKD population is not guaranteed.
watch where the curves separate too. early separation on a kidney endpoint is more surprising than early separation on weight.
that is the figure i keep going back to. it is earlier than i would have predicted.