UK researchers have found that Eplerenone, a drug used widely to treat central serous chorioretinopathy (CSCR), has “no benefit” and should no longer be used.
Primarily used to treat heart failure, Eplerenone decreases the activity of hormones regulating salt and water in the body and was found to improve vision in a small number of patients in early-stage research. However, it is also associated with side effects including raised potassium levels, which can affect heart rhythm and cause a decrease in blood pressure, leading to concerns about its long-term efficacy and safety for treating CSCR, said study lead Professor Andrew Lotery, a consultant ophthalmologist at University Hospital Southampton.
In the study, 111 patients across 22 UK sites received either the medication or placebo for up to 12 months. Published in The Lancet, the results showed there was no real benefit treating patients with eplerenone. Modelled mean best corrected visual acuity (BCVA) at 12 months was 79.5 letters (SD 4.5) in the placebo group and 80.4 letters (4.6) in the eplerenone group, with an adjusted estimated mean difference of 1.73 letters (95% CI −1.12 to 4.57; p=0.24) at 12 months. Hyperkalaemia occurred in eight (14%) patients in each group. No serious adverse events were reported in the eplerenone group and three unrelated serious adverse events were reported in the placebo group.
“This is an important practice-changing finding and should prompt ophthalmologists to stop treating CSCR with eplerenone, instead opting to participate in future trials of other potential interventions,” Prof Lotery concluded.
CSCR causes fluid to accumulate under the retina and can lead to vision loss in up to a third of patients. It is the fourth most common retinal disease and affects 10 in 100,000 men and two in 100,000 women mainly in their 30s and 40s.