Session Title: New Drug Treatment and Technology I
Session Date/Time: Friday 18/09/2015 | 11:00-12:30
Paper Time: 11:08
First Author: : P.Carrai ITALY
Co Author(s): : F. Pichi F. Behar-Cohen P. Nucci
PURPOSE:To compare spironolactone and eplerenone, mineralocorticoid receptor antagonists, as potential treatment for central serous chorioretinopathy
This randomized, placebo-controlled, crossover clinical trial included 30 patients with central serous chorioretinopathy of at least 3-months duration, randomized 1:1:1 to 3 Groups.
Group 1 patients were treated with 25 mg/day of oral spironolactone a week followed by 50 mg/day for 3 weeks, then switched to 50 mg/day oral eplerenone for 1 month; Group 2 patients were treated with 25 mg/day of oral eplerenone a week followed by 50 mg/day for 3 weeks, then switched to 50 mg/day oral spironolactone for 1 month; Group 3 patients were treated with 25 mg/day of oral placebo a week followed by 50 mg/day for 3 weeks, then switched to 50 mg/day oral spironolactone for 1 month. The primary outcome measure was the changes in central retinal thickness (CRT) recorded by optical coherence tomography, and the secondary outcomes included changes in best-corrected visual acuity (BCVA) and the percentage of eyes achieving complete resolution of subretinal fluid during the treatment period.
Central retinal thickness from baseline to crossover decreased significantly from 430.4 ± 163 µm to 340.8 ± 74 µm and from 399.25 ± 76 µm to 319.5 ± 91 µm, in Group 1 and 2 respectively. Two months CRT in Group 1 and 2 were 254.7 ± 96 µm and 287.7 ± 2 µm respectively. CRT of sham patients in Group 3 from 341.4 ± 83 µm at baseline to 331.7 ± 82 µm at crossover, then decreased to 237,6 ± 45 µm after crossing to spironolactone. In the crossover Group 1 and 2, mean initial BCVA was 44.7 ± 7 and 47.8 ± 4 ETDRS letters, improved by 6.2 and 5.8 letters at crossover, and remained stable at conclusion (P=0.91). BCVA of sham patients decreased during the first month, with an average loss of 3.5 letters, then increased or an average gain of 3.2 and 4.1 letters, respectively, 1 and 3 months after rollover.
Both spironolactone and eplerenone are effective for the treatment of CSCR, even if spironolactone appears to have better anatomic outcomes and to achieve a faster resolution of subretinal fluid. Changing treatments from spironolactone to eplerenone did not result in further gains in visual acuity.