A recent study published in the Journal of Ophthalmology investigated the use of spironolactone as a treatment for central serous chorioretinopathy (CSC).
Give me some background first.
Corticosteroids have increasingly been linked as a risk factor for CSC. Further, mineralocorticoid receptor (MR) antagonists have been shown to block the binding of corticosteroids.
And the link to spironolactone?
Spironolactone is the first competitive steroidal MR antagonist, and is mainly used to treat hypertension, hyperaldosteronism, and congestive heart failure.
Researchers here aimed to assess the efficacy of spironolactone in CSC, and distinguish between responders that may benefit from it.
Now, talk about the study.
The interventional retrospective clinical trial was made up of 42 eyes from 42 chronic CSC patients. Participants had been treated at the West China Hospital of Sichuan University between December 2021 and December 2022.
Exclusion criteria was implemented, including the presence of any other ocular disease. Each patient had been treated with 20 mg/tid of spironolactone, three times a day (TID), for three months.
Go on…
Follow-up review occurred at the beginning, as well as at the first, third, and sixth months following treatment. Tests taken comprised of:
- Best-corrected visual acuity (BCVA)
- Slit-lamp examination
- Enhanced depth imaging optical coherence tomography (EDI-OCT)
- OCT-angiography (OCT-A)
- Blood pressure
- Serum electrolytes
What were the outcome measures?
The primary outcome measure was complete resolution of the subretinal fluid (SRF). Secondary measures included:
- BCVA
- SRF area
- Central macular thickness (CMT)
- Subfoveal choroidal thickness (SFCT)
- Density of the choriocapillaris vessel
- Adverse events (AEs)
Findings?
Spironolactone displayed positive effects on SRF, CMT, and SFCT. In 24 of 42 eyes (57.1%), patients experienced resolved SRF following treatment and were put in the “responder” group; all others were delegated to “non-responder” for further comparisons to be made.
The responder group had good visual acuity (VA) and less fluid as baseline compared to nonresponders; however, the difference was not significant.
What else?
Additionally, high rates of CSC recurrence were found, showcasing that long-term treatment may be necessary for “complete resolution of SRF accumulation.”
Tell me more.
The authors suggested that the findings indicate oral MR antagonists may be a better option for patients who are not suitable for or reject invasive treatments.
To note: Minimal AEs occurred, displaying tolerability.
Limitations?
A limitation of this study appeared in the small number of enrolled patients. In addition, the treatment time was relatively short and there were no placebo groups.
Expert opinion?
The authors also noted that imaging predictors could have a preventative effect in those with chronic disease, as spironolactone appeared to improve anatomical results.
Per the study authors, “The baseline choroidal thickness and continuous ellipsoid zone seem to be useful imaging predictors for identifying chronic CSC patients who could have a potentially good response to spironolactone therapy.”
Take home.
The authors concluded, “We report the good effect of oral spironolactone on the regression of SRF and the recovery of the anatomical structure of the retina in patients with chronic CSC.”
While additional research is necessary to confirm findings and address limitations, the study offers new insights and positive implications for the use of spironolactone to treat CSC.