July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
The TAME cCSC (Treat and Maintain for Eplerenone for chronic Central Serous Chorioretinopathy) Study with the Use of Predictive Biomarkers
Author Affiliations & Notes
  • Guneet Sodhi
    Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia, United States
  • Haley D'Souza
    Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia, United States
  • Daniel Barmas-Alamdari
    Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia, United States
  • Homan Mohammadi
    Moffit Cancer Center, Florida, United States
  • Alan Wagner
    Wagner Macula and Retina Center, Virginia, United States
    Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia, United States
  • Kapil Kapoor
    Wagner Macula and Retina Center, Virginia, United States
    Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia, United States
  • Footnotes
    Commercial Relationships   Guneet Sodhi, None; Haley D'Souza, None; Daniel Barmas-Alamdari, None; Homan Mohammadi, None; Alan Wagner, None; Kapil Kapoor, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 4324. doi:
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      Guneet Sodhi, Haley D'Souza, Daniel Barmas-Alamdari, Homan Mohammadi, Alan Wagner, Kapil Kapoor; The TAME cCSC (Treat and Maintain for Eplerenone for chronic Central Serous Chorioretinopathy) Study with the Use of Predictive Biomarkers. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4324.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : There is increasing evidence on the success of eplerenone in treating cCSC, but there is a lack of robust data that specifically outlines proposed dosing regimens. The purpose of this study was to determine the optimal eplerenone induction and maintenance dosing regimen for our large cohort of cCSC patients.

Methods : In this IRB approved multiple physician study, we retrospectively reviewed 434 eyes over 5.5 years (3/2013-9/2018). Baseline and demographic characteristics, treatment regimens and outcomes, and optical coherence tomography (OCT) values were collected over the treatment periods and recorded until the last date of follow up. The Fisher’s exact and Pearson’s Chi-squared tests were used to identify significant associations between the independent variables and treatment outcomes. Binomial and multinomial logistic regressions were employed to determine the direction and strength of these associations and are expressed as odds ratios (OR).

Results : 144 cases were included for statistical review. There was an increased chance of achieving remission and maintaining remission without recurrence with eplerenone 50 mg BID (p=0.002 and p=0.037, respectively). When initiating eplerenone 25 mg BID, there was a lower chance of achieving 2 remissions (p=0.009) and a higher chance for having a refractory treatment course (p=0.017). Being Caucasian correlated with achieving remission (p<0.001). Having no drug side effects correlated with an increased remission rate (p=0.015). Furthermore, having no significant stress factors led to a lower recurrence rate (p=0.05). There was an increased chance of both having a recurrence and having refractory disease with previous steroid use (p=0.028 and p=0.011, respectively).

Conclusions : Our results suggest that the initiation and maintenance of eplerenone 50 mg BID for select patients will have the best effect in achieving remissions. Starting with eplerenone 25 mg BID may be undertreating certain patients. Other prognostic factors influence a patient’s clinical course and can be included in the above dosing regimens. Further prospective data is needed to integrate these dosing regimens with the predictive biomarkers to more precisely elucidate these treatment algorithms.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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