Felipe Camila Q, Biancardi Ana Luiza, Civile Vinicius T, Carvas Junior Nelson, Serracarbassa Pedro D, Koike Marcia K
Postgraduate Program in Health Sciences, Institute of Medical Care for Civil Servants in the State of São Paulo (IAMSPE), São Paulo, Brazil.
Laboratory of Infectious Diseases in Ophthalmology, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil.
Int J Retina Vitreous. 2022 Jun 7;8(1):34. doi: 10.1186/s40942-022-00385-1.
BACKGROUND: Mineralocorticoid receptor antagonists (MRAs) are widely used for chronic central serous chorioretinopathy (cCSCR), but their effectiveness remains unclear. This research was conducted to evaluate the efficacy of this drugs for cCSCR. METHODS: This is a review of randomized clinical trials (RCT) comparing MRAs to placebo in adults with cCSCR, using the effects of MRAs on best-corrected visual acuity (BCVA) and adverse events as primary outcomes and the effects of MRAs on anatomical parameters as secondary outcomes: central subfield thickness (CST), subretinal fluid height (SFH) and central choroidal thickness (CCT). Our all-language online search included Medline (via PubMed), Central, Embase, Lilacs, Ibecs, and RCT registers platforms, as late as May 2021. We used the Cochrane risk-of-bias tool (version 2) to assess the methodological quality of each study and synthesized the results in meta-analyses using a random-effects model. RESULTS: The search identified 302 records, five of which were eligible, totaling 225 cCSCR patients (aged 45-62 years; M/F ratio 3.1:1) treated for 1 to 12 months with spironolactone (50 mg/day) or eplerenone (50 mg/day) vs. placebo. Moderate-certainty evidence suggests MRAs result in little to no improvement in BCVA compared to placebo (SMD 0.22; 95% CI - 0.04 to 0.48; studies = 5; comparisons = 6; participants = 218; I = 0%). Very low-certainty evidence suggests that, when compared to placebo, MRAs have a very uncertain impact on adverse effects (no meta-analysis was performed), and CST (MD 18.1; 95% CI - 113.04 to 76.84; participants = 145; studies = 2; I = 68%). MRAs also result in little to no difference in SFH (SMD - 0.35; 95% CI - 0.95 to 0.26; studies = 5; comparisons = 6; participants = 221; I = 76%; moderate certainty) and CCT (MD - 21.23; 95% CI - 64.69 to 22.24; participants = 206; studies = 4; comparisons = 5; I = 85%; low certainty). CONCLUSION: MRAs have little to no effect on BCVA. Evidence for adverse events and CST is very uncertain. MRAs also have little to no effect on SFH and CCT. These findings should be considered when prescribing MRAs for cCSCR. This research was previous registration in the PROSPERO platform (CRD42020182601).
背景：盐皮质激素受体拮抗剂（MRAs）被广泛用于慢性中心性浆液性脉络膜视网膜病变（cCSCR），但其有效性仍不明确。本研究旨在评估此类药物对cCSCR的疗效。 方法：这是一项对随机临床试验（RCT）的综述，比较了MRAs与安慰剂在成年cCSCR患者中的应用，以MRAs对最佳矫正视力（BCVA）的影响和不良事件作为主要结局，以MRAs对解剖学参数的影响作为次要结局：中心子野厚度（CST）、视网膜下液高度（SFH）和中心脉络膜厚度（CCT）。我们截至2021年5月的全语言在线搜索包括Medline（通过PubMed）、Central、Embase、Lilacs、Ibecs和RCT注册平台。我们使用Cochrane偏倚风险工具（第2版）评估每项研究的方法学质量，并使用随机效应模型在荟萃分析中综合结果。 结果：检索到302条记录，其中5条符合条件，共有225例cCSCR患者（年龄45 - 62岁；男/女比例3.1:1）接受了1至12个月的螺内酯（50毫克/天）或依普利酮（50毫克/天）治疗，与安慰剂进行对比。中等确定性证据表明，与安慰剂相比，MRAs对BCVA的改善甚微或没有改善（标准化均数差0.22；95%置信区间 - 0.04至0.48；研究 = 5；比较 = 6；参与者 = 218；I² = 0%）。极低确定性证据表明，与安慰剂相比，MRAs对不良反应的影响非常不确定（未进行荟萃分析），对CST的影响也是如此（均数差18.1；95%置信区间 - 113.04至76.84；参与者 = 145；研究 = 2；I² = 68%）。MRAs对SFH的影响也甚微或没有差异（标准化均数差 - 0.35；95%置信区间 - 0.95至0.26；研究 = 5；比较 = 6；参与者 = 221；I² = 76%；中等确定性），对CCT的影响同样如此（均数差 - 21.23；95%置信区间 - 64.69至22.24；参与者 = 206；研究 = 4；比较 = 5；I² = 85%；低确定性）。 结论：MRAs对BCVA几乎没有影响。关于不良事件和CST的证据非常不确定。MRAs对SFH和CCT也几乎没有影响。在为cCSCR患者开具MRAs处方时应考虑这些发现。本研究先前已在PROSPERO平台注册（CRD42020182601）。
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