Eplerenone 50mg 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

IntroductionHeart failure with reduced ejection fraction (HFrEF) represents a major clinical and economic burden in Italy, driven by an aging population. Mineralocorticoid receptor antagonists (MRAs) are a cornerstone of guideline-recommended therapy. Eplerenone has demonstrated efficacy in reducing mortality and hospitalizations but remains underutilized. This study assessed the budget impact of increasing eplerenone use in eligible patients with HFrEF from national and regional perspectives.MethodsA budget impact analysis (BIA) was conducted over a 3-year horizon from the perspective of the Italian National Health Service (INHS). Two scenarios were compared: Current (observed MRA use) and Projected (increased eplerenone uptake). Model inputs included eligible population, treatment distribution, drug acquisition costs, and clinical outcomes (all-cause mortality, hospitalizations, renal impairment, hyperkalemia, and gynecomastia) with associated costs. Clinical inputs were derived from a network meta-analysis (NMA); cost inputs from Italian literature and national tariffs.ResultsTotal expenditure increased from €598.6 million (M) to €600.6 M over 3 years, corresponding to a net budget impact of + €2.01 M (+ 0.34%), with annual increments of €880,000 (year 1), €885,000 (year 2), and €245,000 (year 3). Increased eplerenone use resulted in higher costs (+ €35.07 M), driven by drug acquisition and hospitalization costs, partially offset by mortality-related savings (-€3.62 M). These were partially counterbalanced by reductions in other MRAs (spironolactone - €6.37 M, potassium canrenoate - €8.32 M, canrenone - €18.37 M), mainly due to fewer hospitalizations, renal events, and a lower drug volume. Results were primarily driven by clinical parameters for eplerenone, particularly NMA-derived hazard ratios for hospitalization and all-cause mortality. The net budget impact was modest in relative terms (ConclusionsGreater adoption of eplerenone was associated with a modest net increase in healthcare expenditure for the INHS, corresponding to approximately €3.20 per treated patient per year and consistent with substantial budget neutrality. The budget impact reflects both treatment redistribution and differences in clinical outcomes across MRAs. Expanding eplerenone use in line with guideline-recommended therapy may be achieved at a limited additional cost, while offering a more favorable renal and selectivity profile relative to other MRAs.

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Mineralocorticoid receptor antagonists (MRAs), aldosterone synthase inhibitors (ASIs), and epithelial sodium channel (ENaC) blockade target different levels of the aldosterone-related sodium-retention pathway in resistant hypertension (RH), but the comparative efficacy of individual agents remains uncertain. We conducted a focused drug-level network meta-analysis of randomized controlled trials (RCTs) comparing pathway-directed therapies in adults with RH. PubMed, Scopus, Embase, Cochrane CENTRAL, Cochrane Reviews, and ClinicalTrials.gov were searched from inception to July 20, 2026. The primary outcome was change in office systolic blood pressure (BP). Secondary outcomes included office diastolic BP and 24-hour ambulatory systolic and diastolic BP. Ten RCTs including 2865 participants were analyzed. In the primary drug-level analysis, amiloride, spironolactone, baxdrostat, eplerenone, and lorundrostat significantly reduced office systolic BP compared with placebo, with mean differences (MDs) of -14.08, -10.78, -9.09, -8.14, and -6.80 mmHg, respectively. Osilodrostat showed a statistically uncertain effect, with an MD of -2.61 mmHg. At the class level, both MRAs and ASIs showed clinically meaningful reductions in office systolic BP. Secondary outcomes were generally consistent with the primary analysis, although fewer trials contributed to these networks. Sensitivity analyses did not materially change the primary findings. These results support the aldosterone-related sodium-retention pathway as an important therapeutic target in RH. MRAs remain the established reference add-on therapy, whereas newer ASIs and amiloride may represent pathway-based alternatives for selected patients. Trial Registration: INPLASY202670099.

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Atrial arrhythmia recurrence after catheter ablation for atrial fibrillation (AF) remains common despite advances in pulmonary vein isolation, mapping, lesion delivery, and rhythm monitoring. Contemporary guidelines emphasize integrated, risk-factor-based care, yet the roles of serum potassium management and mineralocorticoid receptor antagonist (MRA) therapy after ablation remain poorly defined. We aimed to synthesize the clinical and mechanistic evidence on whether serum potassium, potassium-management strategies, and MRA therapy (steroidal: spironolactone, eplerenone; nonsteroidal: esaxerenone, finerenone) modify recurrence, and to derive a testable mechanistic framework. Considering these backgrounds, we conducted a narrative review supported by a systematic literature search, prepared with reference to the PRISMA 2020 principles for transparency of search and selection and, because clinical heterogeneity precluded meta-analysis, the Synthesis Without Meta-analysis (SWiM) guideline. PubMed/MEDLINE and public professional society repositories were searched from inception to 6 June 2026, supplemented by hand searching; eligibility was prespecified using a PICOS framework. Study selection and extraction were performed in duplicate. The risk of bias was assessed using RoB 2 (randomized trials) and ROBINS-I (non-randomized studies). Findings were synthesized narratively across a prespecified evidence hierarchy (direct, indirect, mechanistic). Direct evidence was limited to five studies and was constrained by heterogeneity, small sample sizes in the MRA studies, and moderate-to-serious risk of bias in most non-randomized comparisons. One registry cohort (n = 4,838) reported a U-shaped association between preprocedural potassium and one-year recurrence, with the lowest observed risk at 4.41-4.60 mmol/L; however, this observational association does not establish an optimal therapeutic target or benefit from supplementation. Among four small/heterogeneous MRA studies, eplerenone and a single-center spironolactone randomized trial showed favorable recurrence signals, whereas retrospective esaxerenone showed no recurrence reduction despite improvements in secondary biomarker and remodeling measures; another study used renal sympathetic denervation as an active comparator and therefore did not establish MRA benefit over usual care. These findings should be interpreted cautiously because of study limitations, imprecision, confounding by indication, and variable recurrence ascertainment. Indirect evidence from non-ablation populations and mechanistic studies supports biological plausibility for interactions among potassium homeostasis, mineralocorticoid signaling, renal function, and atrial remodeling, but cannot validate a post-ablation treatment strategy. Accordingly, the proposed ionic-renal-aldosterone-fibrosis axis should be regarded as a hypothesis-generating framework rather than a clinically validated mechanism. Current evidence supports avoiding hypokalemia and hyperkalemia, correcting reversible disturbances, and prescribing MRAs for established indications with appropriate monitoring; it does not justify routine potassium supplementation or MRA use solely to prevent post-ablation recurrence. Prospective, adequately powered randomized studies with longitudinal potassium assessment and rigorous rhythm monitoring are required before mechanism-based post-ablation interventions can be recommended.

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BackgroundThere are concerns that renin-angiotensin system inhibitors are less effective in Black patients than non-Black patients with heart failure (HF). We examined the efficacy and safety of mineralocorticoid-receptor antagonists (MRAs), compared with placebo, in patients with HF with reduced ejection fraction or HF with mildly reduced/preserved ejection fraction, according to self-reported race (Black or non-Black).MethodsThis was a post hoc individual participant data meta-analysis of the 4 large placebo-controlled trials comparing MRAs to placebo in patients with HF with reduced ejection fraction (RALES [Randomized Aldactone Evaluation Study], EMPHASIS-HF [Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure]) and HF with mildly reduced/preserved ejection fraction (TOPCAT [Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist], FINEARTS-HF [Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure]). The primary outcome was a composite of cardiovascular death or first HF hospitalization.ResultsOf the 13 846 patients randomized in the 4 trials, 577 (4.2%) identified as Black. Despite being younger (64 versus 70 years), rates of HF hospitalizations and death were higher in Black than non-Black patients. The hazard ratio for MRA versus placebo for the primary composite outcome was 0.87 (95% CI, 0.66-1.15) in Black patients and 0.77 (95% CI, 0.72-0.82) in non-Black patients (Pinteraction=0.34), with 3.9 and 2.7 fewer events per 100 person-years of treatment, respectively. For first HF hospitalization, the hazard ratios were 0.86 (95% CI, 0.63-1.17) and 0.73 (95% CI, 0.68-0.80) for Black and non-Black patients, respectively (Pinteraction=0.36). The corresponding hazard ratios for cardiovascular death were 0.75 (95% CI, 0.48-1.17) and 0.81 (95% CI, 0.74-0.90), respectively (Pinteraction=0.80). Adverse events with MRAs, compared with placebo, were not modified by race. The effects of MRAs in patients with HF with reduced ejection fraction and HF with preserved ejection fraction, individually, were not modified by race.ConclusionsThere was no statistically significant evidence of heterogeneity in the absolute or relative effects of MRAs on clinical outcomes between Black and non-Black patients with HF, regardless of HF phenotype.

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