Mineralocorticoid receptor antagonists for chronic central serous chorioretinopathy: systematic review and meta-analyses

Camila Q Felipe; Ana Luiza Biancardi; Vinicius T Civile; Nelson Carvas Junior; Pedro D Serracarbassa; Marcia K Koike

doi:10.1186/s40942-022-00385-1

Mineralocorticoid receptor antagonists for chronic central serous chorioretinopathy: systematic review and meta-analyses

Int J Retina Vitreous. 2022 Jun 7;8(1):34. doi: 10.1186/s40942-022-00385-1.

Authors

Camila Q Felipe¹, Ana Luiza Biancardi², Vinicius T Civile³, Nelson Carvas Junior⁴, Pedro D Serracarbassa⁵, Marcia K Koike^{6

7}

Affiliations

¹ Postgraduate Program in Health Sciences, Institute of Medical Care for Civil Servants in the State of São Paulo (IAMSPE), São Paulo, Brazil.
² Laboratory of Infectious Diseases in Ophthalmology, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil.
³ Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
⁴ Cochrane Brazil and Department of Physiotherapy, Paulista University, São Paulo, Brazil.
⁵ Postgraduate Program in Health Sciences, IAMSPE, São Paulo, Brazil.
⁶ Postgraduate Program in Health Sciences, IAMSPE and Laboratory of Medical Investigation 51 (LIM-51), University of São Paulo, São Paulo, Brazil. mkkoike17@gmail.com.
⁷ Postgraduate Program in Health Sciences of the Institute of Medical Care for Civil Servants in the State of São Paulo (IAMSPE), Avenida Ibirapuera 981, 2 andar, Vila Clementino, São Paulo, SP, CEP 04029-000, Brazil. mkkoike17@gmail.com.

Abstract

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; I² = 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; I² = 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; I² = 76%; moderate certainty) and CCT (MD - 21.23; 95% CI - 64.69 to 22.24; participants = 206; studies = 4; comparisons = 5; I² = 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).

Keywords: Central Serous Chorioretinopathy; Eplerenone; Mineralocorticoid Receptor Antagonists; Spironolactone.