Pichi Francesco, Carrai Paola, Ciardella Antonio, Behar-Cohen Francine, Nucci Paolo
Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
San Giuseppe Hospital, University Eye Clinic, Milan, Italy.
Int Ophthalmol. 2017 Oct;37(5):1115-1125. doi: 10.1007/s10792-016-0377-2. Epub 2016 Oct 18.
To evaluate the effect of oral spironolactone and eplerenone, two specific antagonists of the mineralocorticoid receptor, in central serous chorioretinopathy (CSCR).
In this prospective, placebo-controlled trial, sixty patients with persistent CSCR were assigned to three treatment group. Twenty patients in Group 1 were treated with 25 mg of spironolactone (Aldactone; Pfizer) for 1 week, then increased to 50 mg for the following 3 weeks, then shifted to eplerenone 50 mg for 1 month. Twenty patients in Group 2 were treated with 25 mg of eplerenone (Inspra; Pfizer) for 1 week, then increased to 50 mg for the following 3 weeks, and then shifted to spironolactone 50 mg for 1 month. Twenty patients in Group 3 were treated with 1 placebo control tablet for 1 week, then increased to two tablets for the following 3 weeks, and then shifted to spironolactone 50 mg for 1 month. At the end of the second month, all the treatments were stopped, and the patients were followed for two additional months. Primary outcome measure was a change in BCVA at 1, 2, and 4 months. Secondary outcome was a change of >20 % in the size of SRF recorded with OCT at 1, 2, and 4 months of treatment.
In terms of BCVA, treatment in Group 1 was effective from the first month (spironolactone, p value 0.01), and in Group 2 effective from the second month (shift to spironolactone, p value 0.004). Since the p value after the first month was 0.2 in Group 2, even with a larger sample, it would be difficult to see an efficacy of an eplerenone treatment after 1 month. As for the SRF, both in Group 1 and Group 2, both treatments were found to be equally effective after 1 month of administration (p values 0.004). At 4 months, only in Group 3, there was no statistical improvement of BCVA and SRF (p values 0.09 and 0.5).
Spironolactone is statistically superior to eplerenone in improving BCVA of patients with CSCR, while both drugs can be considered equally effective in promoting the reabsorption of SRF.
评估盐皮质激素受体的两种特异性拮抗剂——口服螺内酯和依普利酮对中心性浆液性脉络膜视网膜病变（CSCR）的疗效。
在这项前瞻性、安慰剂对照试验中，60例持续性CSCR患者被分为三个治疗组。第1组20例患者先服用25mg螺内酯（安体舒通；辉瑞公司）1周，然后在接下来的3周内增至50mg，之后换用50mg依普利酮治疗1个月。第2组20例患者先服用25mg依普利酮（ Inspra；辉瑞公司）1周，然后在接下来的3周内增至50mg，之后换用50mg螺内酯治疗1个月。第3组20例患者先服用1片安慰剂对照片1周，然后在接下来的3周内增至2片，之后换用50mg螺内酯治疗1个月。在第二个月末，所有治疗均停止，患者再随访2个月。主要观察指标为1、2和4个月时最佳矫正视力（BCVA）的变化。次要观察指标为治疗1、2和4个月时，光学相干断层扫描（OCT）记录的视网膜下液（SRF）大小变化>20%。
就BCVA而言，第1组从第一个月起治疗有效（螺内酯，p值0.01），第2组从第二个月起有效（换用螺内酯，p值0.004）。由于第2组第一个月后的p值为0.2，即使样本量更大，也很难看出依普利酮治疗1个月后的疗效。至于SRF，第1组和第2组在给药1个月后，两种治疗均被发现同样有效（p值0.004）。在4个月时，仅第3组的BCVA和SRF无统计学改善（p值0.09和0.5）。
在改善CSCR患者的BCVA方面，螺内酯在统计学上优于依普利酮，而两种药物在促进SRF重吸收方面可被认为同样有效。
