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  • Eplerenone or Placebo for Chronic Central Serous Chorioretinopathy

    By Lynda Seminara
    Selected By: Prem S. Subramanian, MD, PhD
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    Journal Highlights

    Lancet
    2020;395(10220):294-303

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    Many ophthalmologists now prescribe eplerenone as first-line treatment for central serous chorioretinopathy (CSCR), but research by Lotery et al. may cause them to reconsider this prac­tice. Results of their study showed that by 12 months of treatment, eplerenone was no better than placebo for improv­ing best-corrected visual acuity (BCVA), leading the authors to discourage the drug’s use.

    For this placebo-controlled study, adults with treatment-naive CSCR for at least four months were assigned ran­domly (1:1) to receive oral eplerenone (25 mg/day for one week, increasing to 50 mg/day for up to 12 months) or placebo, in addition to usual care for all. The primary study outcome was BCVA at 12 months.

    Overall, 57 patients received epler­enone and 57 had placebo. All patients in the eplerenone group and 54 from the placebo group were included in the primary outcome analysis. The mean age at randomization was 48.7 years; 75% of patients were male, and 87% were white.

    Modeled mean (standard deviation) BCVA at 12 months was 80.4 (4.6) letters in the eplerenone group and 79.5 (4.5) letters in the placebo group. No meaningful difference in BCVA was found between the groups at 12 months; the adjusted estimated mean difference was 1.73 letters (p = .24). Although central subfield retinal thick­ness (SRF) did not differ significantly between the two groups, a difference in SRF thickness was noted at 12 months, favoring placebo (p = .0066). Eight patients in each group experienced hyperkalemia. Three patients in the placebo group had a serious adverse nonophthalmic event.

    The authors recommend that oph­thalmologists discourage eplerenone use for CSCR and instead urge their patients to participate in clinical trials of other therapies.

    The original article can be found here.