Real-world practice patterns of eplerenone use for central serous chorioretinopathy

Ramesh Venkatesh; Vishma Prabhu; Aishwarya Joshi; Rubble Mangla; Rishi Singh; Lihteh Wu; Paolo Lanzetta; Baruch Kuppermann; Francesco Bandello; Francine Behar Cohen; Jay Chhablani

doi:10.1186/s40942-023-00500-w

Real-world practice patterns of eplerenone use for central serous chorioretinopathy

Int J Retina Vitreous. 2023 Oct 2;9(1):61. doi: 10.1186/s40942-023-00500-w.

Authors

Ramesh Venkatesh¹, Vishma Prabhu², Aishwarya Joshi², Rubble Mangla², Rishi Singh^{3

4}, Lihteh Wu⁵, Paolo Lanzetta^{6

7}, Baruch Kuppermann⁸, Francesco Bandello^{9

10}, Francine Behar Cohen^{11

12}, Jay Chhablani¹³

Affiliations

¹ Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, Bangalore, 560022, India. vramesh80@yahoo.com.
² Department of Retina and Vitreous, Narayana Nethralaya #121/C, 1st R block, Rajaji Nagar, Bangalore, 560022, India.
³ Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
⁴ Cleveland Clinic Martin Health, Stuart, FL, USA.
⁵ Macula, Vitreous and Retina Associates of Costa Rica, San José, Costa Rica.
⁶ Department of Medicine - Ophthalmology, University of Udine, Udine, Italy.
⁷ Istituto Europeo di Microchirurgia Oculare, Udine, Italy.
⁸ Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, 92697, USA.
⁹ School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
¹⁰ Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
¹¹ Centre de Recherche des Cordeliers, From Physiopathology of Retinal Diseases to Clinical Advances, Université de Paris Cité, Inserm, Paris, 75006, France.
¹² Department of Ophthalmology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Ophtalmopôle, Paris, 75014, France.
¹³ Department of Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA.

Abstract

Purpose: To report eplerenone use by retina specialists worldwide for central serous chorioretinopathy (CSCR).

Methods: A self-reporting questionnaire was distributed to retina specialists worldwide to gather clinicians' perspectives on CSCR cases treated, eplerenone dosage and duration, reasons to use it, and side effects.

Results: The survey included 241 retina specialists (122 Indian and 119 international) with an average experience of 15.69 ± 9.59 years. Oral eplerenone was used to treat CSCR by 149 (62%) participants. Only 6% (n = 9) had easy access to verteporfin dye and photodynamic therapy. 30 (20%) of the 149 respondents changed their treatment with eplerenone after VICI trial results. Eplerenone was prescribed mostly for chronic CSCR (n = 86, 58%), regardless of involvement laterality. 62% (n = 92) had fewer than 25% CSCR cases treated with eplerenone. 85 (57%) respondents used eplerenone only when other treatments failed, while 36 (24%) used it as first-line treatment. 73 (49%) respondents, prescribed eplerenone at a 50 mg daily dose and 137 (92%) retina specialists used eplerenone for 0-3 months. The drug's efficacy dissatisfied 21 (14%) study participants. 124 (83%) study participants did not encounter any ocular or systemic side effects with eplerenone use. Eplerenone related kidney and electrolyte issues were noted by 11 (7%) study participants.

Conclusion: The treatment of CSCR varies around the world and is primarily influenced by the photodynamic therapy availability and the findings of VICI trial. Despite the limited benefit of eplerenone reported by the VICI trial, it is still used as evidenced by real-world experience.

Trial registration number: Not applicable.

Keywords: Central serous chorioretinopathy; Eplerenone; Real-world patterns; Side-effects; Treatment.