- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01822561
Eplerenone for Central Serous Chorioretinopathy
April 17, 2018 updated by: Tufts Medical Center
Eplerenone for Central Serous Chorioretinopathy: A Pilot Study
- The goal of the study is to examine the short-term effects and safety of a systemic anti-aldosterone medication, eplerenone, in a small group of patients with central serous chorioretinopathy (CSCR).
- There is currently no standard treatment or therapy for either acute or chronic CSCR, a potentially debilitating eye disease.
- There is evidence in both animals and humans that high blood serum corticosteroid levels can cause or worsen CSCR or findings similar to CSCR in the choroid and retina
- Eplerenone, a mineralocorticoid receptor antagonist, has been shown to be of visual and anatomic benefit in a small series of 4 patients with chronic CSCR, suggesting that decreasing mineralocorticoid action in the eye may improve signs and symptoms of CSCR
- The investigators' aim is to evaluate a standardized dose of eplerenone in a controlled prospective fashion for both acute and chronic CSCR.
- The study consists of taking a standard dose of eplerenone, 50mg once daily, for 1 month
- Over the course of the month, patients will be monitored for side effects, as well as visual and anatomical response to the medication
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
- The investigators hypothesize that aldosterone inhibition with eplerenone will decrease choroidal vessel vasodilation, focal leakage, and choroidal thickness in patients with both acute and chronic CSCR, leading to resolution of subretinal fluid and ultimately an improvement in symptoms.
- Resolution of sub-retinal fluid will be the primary outcome, which can be precisely measured using optical coherence tomography (OCT)
- Secondary outcomes will include: Change in macular thickness measured with OCT, in central macular circle thickness on OCT, change in visual acuity, change in dye leakage characteristics on fluorescein angiography, change in OCT characteristics of the fellow eye, and safety and tolerability characteristics
- In acute CSCR, subretinal fluid often resolves on its own, but it often takes several months (the literature shows that ~20% of patients have complete resolution of sub-retinal fluid on OCT 1 month after presentation)
- Chronic CSCR is defined as persistent fluid on OCT after 3 months of symptom onset, or recurrence of signs and symptoms within 1 year after the prior episode
- In this study, the investigators will not make a distinction between acute and chronic CSCR
- Eplerenone, a generic medication, is a potassium sparing diuretic, which is FDA approved to treat heart failure as well as high blood pressure, but is not FDA approved for treatment of central serous chorioretinopathy.
- The most important side effect of eplerenone is elevation of serum potassium and decrease of blood pressure
- Patients will therefore be screened with routine blood tests as suggested by the package insert of the medication, and serum potassium and blood pressure will be monitored routinely as directed by the medication package insert
- Study visits will be performed at therapy initiation, 1 week, 2 weeks, and 4 weeks
Study Type
Interventional
Enrollment (Actual)
17
Phase
- Phase 2
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02111
- New England Eye Center / Tufts Medical Center
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 65 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Age 18 or over
- Ability to give written informed consent
- Presence of sub-retinal fluid under the fovea as seen on OCT
Diagnosis of Acute or Chronic CSCR:
- Acute CSCR: First presentation to eye clinic with visual symptoms, including decreased vision or visual distortion, and the characteristic appearance of CSCR on examination, fluorescein angiography, and OCT.
- Chronic CSCR: Previous diagnosis of CSCR, persistent subretinal fluid on OCT for more than 3 months after initial presentation to the eye clinic, and <50% reduction in fluid thickness on OCT after 3 months. Patients who have had previous treatment for CSCR may be included.
Exclusion Criteria:
- Age less than 18
- Persons with impaired decision-making ability.
- Women who are known to be pregnant or are actively trying to conceive.
- Additional eye disease affecting the macula or posterior retina.
- At screening, serum potassium concentration ≥5.0 mEq/L , a serum creatinine concentration >2 mg/dL in men and >1.8 mg/dL in women, or a creatinine clearance <50 mL/min, and during concomitant administration of potassium supplements, potassium-sparing diuretics, and/or potent CYP3A4 inhibitors (amifostine, cyclosporine, fluconazole, itraconazole, ketoconazole, mifepristone, posaconazole, potassium salts, Rituximab, tacrolimus or voriconazole).
- Patients with type 2 diabetes will be screened for microalbuminuria with a urinalysis. If microalbuminuria is present, these patients will be excluded.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Eplerenone
All patients in this study will receive Eplerenone 50mg once daily for 4 weeks.
|
All patients will receive the same dose of eplerenone.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Complete Resolution of Subretinal Fluid
Time Frame: Baseline and 1 month after treatment
|
Optical coherence tomography is an imaging technique capable of extremely high resolution (~5-7 microns) imaging of the macula, and is able to detect the presence and amount of subretinal fluid present, the key anatomic abnormality in Central Serous Chorioretinopathy
|
Baseline and 1 month after treatment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Macular Thickness
Time Frame: Baseline and 1 month after treatment
|
Automated software to calculate the thickness of the macula is standard on commercial OCT devices.
Macular thickness before and after treatment will be assessed and compared.
|
Baseline and 1 month after treatment
|
Change in Best Corrected Visual Acuity
Time Frame: Baseline and 1 month after treatment
|
Visual acuity will be measured with standard eye charts, with manifest refraction at the initiation and conclusion of treatment.
Although an important measure, this was not chosen as the primary outcome measure, as some patients with central serous chorioretinopathy may have a normal visual acuity when properly refracted (refraction can change with elevation of the macula by sub-retinal fluid)
|
Baseline and 1 month after treatment
|
Change in Subfoveal Choroidal Thickness, Study Eye
Time Frame: Baseline and 1 month after treatment
|
Choroidal thickness can be measured using optical coherence tomography, and is known to be affected in patients with central serous chorioretinopathy.
Thickness of the choroid under the fovea will be manually calculated in both the study eye.
|
Baseline and 1 month after treatment
|
Change in Serum Potassium
Time Frame: Baseline and 1 month after treatment
|
Eplerenone can cause elevation of serum potassium.
After initial screening, serum potassium was evaluated at 1 and 4 weeks after baseline.
|
Baseline and 1 month after treatment
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Andre J Witkin, MD, Tufts Medical Center
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B, Bittman R, Hurley S, Kleiman J, Gatlin M; Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study Investigators. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003 Apr 3;348(14):1309-21. doi: 10.1056/NEJMoa030207. Epub 2003 Mar 31. Erratum In: N Engl J Med. 2003 May 29;348(22):2271.
- Imamura Y, Fujiwara T, Margolis R, Spaide RF. Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy. Retina. 2009 Nov-Dec;29(10):1469-73. doi: 10.1097/IAE.0b013e3181be0a83.
- Zhao M, Celerier I, Bousquet E, Jeanny JC, Jonet L, Savoldelli M, Offret O, Curan A, Farman N, Jaisser F, Behar-Cohen F. Mineralocorticoid receptor is involved in rat and human ocular chorioretinopathy. J Clin Invest. 2012 Jul;122(7):2672-9. doi: 10.1172/JCI61427. Epub 2012 Jun 11.
- Gemenetzi M, De Salvo G, Lotery AJ. Central serous chorioretinopathy: an update on pathogenesis and treatment. Eye (Lond). 2010 Dec;24(12):1743-56. doi: 10.1038/eye.2010.130. Epub 2010 Oct 8.
- Bouzas EA, Karadimas P, Pournaras CJ. Central serous chorioretinopathy and glucocorticoids. Surv Ophthalmol. 2002 Sep-Oct;47(5):431-48. doi: 10.1016/s0039-6257(02)00338-7.
- Chan WM, Lai TY, Lai RY, Liu DT, Lam DS. Half-dose verteporfin photodynamic therapy for acute central serous chorioretinopathy: one-year results of a randomized controlled trial. Ophthalmology. 2008 Oct;115(10):1756-65. doi: 10.1016/j.ophtha.2008.04.014. Epub 2008 Jun 5.
- Reibaldi M, Cardascia N, Longo A, Furino C, Avitabile T, Faro S, Sanfilippo M, Russo A, Uva MG, Munno F, Cannemi V, Zagari M, Boscia F. Standard-fluence versus low-fluence photodynamic therapy in chronic central serous chorioretinopathy: a nonrandomized clinical trial. Am J Ophthalmol. 2010 Feb;149(2):307-315.e2. doi: 10.1016/j.ajo.2009.08.026. Epub 2009 Nov 6.
- Robertson DM, Ilstrup D. Direct, indirect, and sham laser photocoagulation in the management of central serous chorioretinopathy. Am J Ophthalmol. 1983 Apr;95(4):457-66. doi: 10.1016/0002-9394(83)90265-9.
- Nielsen JS, Jampol LM. Oral mifepristone for chronic central serous chorioretinopathy. Retina. 2011 Oct;31(9):1928-36. doi: 10.1097/IAE.0b013e31821c3ef6.
- Forooghian F, Meleth AD, Cukras C, Chew EY, Wong WT, Meyerle CB. Finasteride for chronic central serous chorioretinopathy. Retina. 2011 Apr;31(4):766-71. doi: 10.1097/IAE.0b013e3181f04a35.
- Weinberger MH, Roniker B, Krause SL, Weiss RJ. Eplerenone, a selective aldosterone blocker, in mild-to-moderate hypertension. Am J Hypertens. 2002 Aug;15(8):709-16. doi: 10.1016/s0895-7061(02)02957-6.
- Fujimoto H, Gomi F, Wakabayashi T, Sawa M, Tsujikawa M, Tano Y. Morphologic changes in acute central serous chorioretinopathy evaluated by fourier-domain optical coherence tomography. Ophthalmology. 2008 Sep;115(9):1494-500, 1500.e1-2. doi: 10.1016/j.ophtha.2008.01.021. Epub 2008 Apr 18.
- Moein HR, Bierman LW, Novais EA, Moreira-Neto C, Baumal CR, Rogers A, Duker JS, Witkin AJ. Short-term eplerenone for treatment of chronic central serous chorioretinopathy; a prospective study. Int J Retina Vitreous. 2019 Sep 9;5:39. doi: 10.1186/s40942-019-0190-y. eCollection 2019.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
May 1, 2013
Primary Completion (Actual)
April 1, 2017
Study Completion (Actual)
December 1, 2017
Study Registration Dates
First Submitted
March 25, 2013
First Submitted That Met QC Criteria
April 1, 2013
First Posted (Estimate)
April 2, 2013
Study Record Updates
Last Update Posted (Actual)
May 16, 2018
Last Update Submitted That Met QC Criteria
April 17, 2018
Last Verified
April 1, 2018
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Eye Diseases
- Retinal Diseases
- Central Serous Chorioretinopathy
- Physiological Effects of Drugs
- Antihypertensive Agents
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Natriuretic Agents
- Diuretics
- Hormone Antagonists
- Mineralocorticoid Receptor Antagonists
- Diuretics, Potassium Sparing
- Eplerenone
Other Study ID Numbers
- NEEC-10722
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Undecided
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Central Serous Chorioretinopathy
-
Shiraz University of Medical SciencesRecruiting
-
Radboud University Medical CenterOogziekenhuis RotterdamRecruitingChronic Central Serous ChorioretinopathyNetherlands
-
Radboud University Medical CenterUniversity of Oxford; University of Cologne; Leiden University Medical Center; University...CompletedChronic Central Serous ChorioretinopathyNetherlands, France, Germany, United Kingdom
-
Università degli Studi di BresciaUnknownChronic Central Serous Chorioretinopathy
-
Manhattan Eye, Ear & Throat HospitalLuEsther T. Mertz Retinal Research CenterCompletedChronic Central Serous ChorioretinopathyUnited States
-
Manhattan Eye, Ear & Throat HospitalCompletedChronic Central Serous ChorioretinopathyUnited States
-
Sun Yat-sen UniversityCompletedAcute Central Serous ChorioretinopathyChina
-
Ankara Universitesi TeknokentCompletedCentral Serous Chorioretinopathy | Chronic Central Serous ChorioretinopathyTurkey
-
Leiden University Medical CenterRadboud University Medical Center; Academisch Medisch Centrum - Universiteit...UnknownChronic Central Serous ChorioretinopathyNetherlands
-
Manhattan Eye, Ear & Throat HospitalAlcon Research; LuEsther T. Mertz Retinal Research CenterCompletedChronic Central Serous ChorioretinopathyUnited States
Clinical Trials on Eplerenone 50mg
-
University of MichiganNational Heart, Lung, and Blood Institute (NHLBI)WithdrawnHypertensionUnited States
-
Pr. Nicolas GIRERDRecruitingKidney Transplantation for More Than One Year | Patients With a Kidney Transplantation on CyclosporineFrance
-
HK inno.N CorporationCompletedHealthyKorea, Republic of
-
LG ChemCompleted
-
Sihuan Pharmaceutical Holdings Group Ltd.Unknown
-
Vanderbilt University Medical CenterNational Center for Research Resources (NCRR)Completed
-
CSPC ZhongQi Pharmaceutical Technology Co., Ltd.UnknownDiabetic Peripheral Neuropathy
-
HK inno.N CorporationRecruitingHealthy | Hepatic ImpairmentKorea, Republic of