Eplerenone 25mg tablets

BACKGROUND: Central serous chorioretinopathy (CSCR) is a common retinal disorder characterized by serous retinal detachment and choroidal abnormalities. While various treatment modalities exist, their potential adverse effects have prompted interest in alternative therapies. Although mineralocorticoid receptor antagonists (MRAs) have been explored as a potential therapy, previous studies have yielded conflicting results, and prior meta-analyses have not distinguished between the effects of selective and nonselective MRAs. Therefore, in this study, we aimed to compare the efficacy and safety of selective (eplerenone) and nonselective (spironolactone) MRAs for treating CSCR. METHODS: A systematic review was conducted using the MEDLINE, Embase, CENTRAL, Web of Science, Scopus Database, Cochrane Library and Google Scholar databases to identify randomized clinical trials (RCTs) comparing the efficacy of MRAs with placebo or between different MRAs in CSCR treatment. Efficacy was evaluated using best-corrected visual acuity (BCVA) and subretinal fluid (SRF) height, and clinical data on adverse effects were also collected. The Revised Cochrane Risk-of-Bias Tool (RoB2) was used for quality assessment. Results were synthesized through a meta-analysis to calculate the weighted mean difference (MD) using a random-effects model. Additionally, a network meta-analysis was performed to incorporate all the evidence. RESULTS: Seven RCTs, involving 283 participants, were included in the analysis. Spironolactone demonstrated a superior effect over placebo in improving BCVA (MD: − 0.14; 95% CI: − 0.25, − 0.04; P = 0.02, I2 = 68%) and reducing SRF height (MD: − 97.42; 95% CI: − 148.19, − 46.66; P = 0.94, I2 = 0%). Eplerenone exhibited a superior effect over placebo in improving BCVA (MD: − 0.0.5; 95% CI: − 0.09, − 0.01; P = 0.41, I2 = 0%) but had no significant impact on SRF height (MD: − 64.80; 95% CI: − 180.40, 50.80; P = 0.0008, I2 = 82%). Synthesizing them all indicated that spironolactone was superior to eplerenone in improving BCVA (MD: 0.13; 95% CI: 0.023, 0.23), though no significant difference was observed on SRF height (MD: − 12; 95% CI: − 170, 150). CONCLUSIONS: Spironolactone was effective in treating CSCR; superior to eplerenone especially in improving BCVA. PROTOCOL REGISTRATION: This systematic review protocol was registered in PROSPERO (ID: CRD42024601746) prior to commencement.

Abstract licence: CC BY-NC-ND

BackgroundMineralocorticoid receptor antagonists (MRAs) are established for heart failure with reduced ejection fraction (HFrEF), but their benefits in mildly reduced/preserved EF (HFmrEF/HFpEF) and agent-specific profiles require clarification. This meta-analysis aimed to evaluate the efficacy, safety, and benefit-risk profiles of MRAs across heart failure phenotypes and agents.MethodsThis meta-analysis synthesized data from randomized controlled trials (RCTs). The primary outcome was a composite of hospitalization for heart failure (HHF) or cardiovascular death. Secondary outcomes included HHF, cardiovascular/all-cause mortality, and safety endpoints. Subgroup analyses examined heart failure phenotypes and MRA agents. Benefit-risk was quantified via Number Needed to Treat/Harm (NNT/NNH).ResultsData from six RCTs (FINEARTS-HF, EPHESUS, EMPHASIS-HF, J-EMPHASIS-HF, TOPCAT, RALES; n = 20,699) were synthesized. MRAs significantly reduced the primary composite outcome (HR = 0.79, 95% CI 0.71-0.88; P 2.24yr =22.4), with consistent effects across demographic subgroups. Reductions were also observed in cardiovascular mortality (HR = 0.82, NNT2.24yr = 45.5), sudden cardiac death (HR = 0.78, NNT2.24yr = 67), HHF (HR = 0.76, NNT2.24yr = 25), and all-cause mortality (HR = 0.84, NNT2.24yr = 39.1). Safety analyses revealed increased risks of hyperkalemia (K⁺ >5.5 mmol/L: OR = 2.29, NNH2.24yr = 12.7), hypotension (OR = 1.52, NNH2.24yr = 23.3), and renal impairment (creatinine ≥ 2.5 mg/dL: OR = 1.63, NNH2.24yr = 49.2), alongside a decreased risk of hypokalemia (K⁺ 2.24yr = 17.3). Subgroup analyses demonstrated significant mortality benefits in HFrEF (cardiovascular mortality HR = 0.77; all-cause mortality HR = 0.78), although hospitalization benefits extended to both HFrEF and HFmrEF/HFpEF. Eplerenone demonstrated significant mortality reduction (cardiovascular mortality HR = 0.81; all-cause mortality HR = 0.83), while spironolactone only showed significant HHF reduction (HR = 0.73).DiscussionMRAs significantly reduce composite cardiovascular outcomes across heart failure phenotypes, with mortality benefits predominantly in HFrEF. Eplerenone appears to offer stronger mortality advantages, while spironolactone is more effective in reducing hospitalizations. These findings support phenotype- and agent-specific strategies to optimize the benefit-risk profile of MRA therapy in heart failure.

Abstract licence: CC BY-NC-ND