Extension Study for the Evaluation of Finasteride in the Treatment of Chronic Central Serous Chorioretinopathy
- Central serous chorioretinopathy (CSC) is a disease in which fluid accumulates under the retina and can cause distorted vision. CSC often resolves on its own without treatment, but in chronic CSC the persists and can lead to permanent visual loss. Chronic CSC may partly be caused by hormones called androgens, such as testosterone.
- Finasteride is a drug that can block the effects of androgens; currently it is marketed as a treatment for male pattern baldness and benign prostate enlargement. The results of a previous brief study suggest that finasteride is safe and may help reduce the effects of chronic CSC. However, more long-term data are needed to evaluate whether finasteride is a safe and effective treatment for chronic CSC.
- To collect more data on the safety and effectiveness of finasteride as a treatment for chronic central serous chorioretinopathy.
- Individuals who previously participated in NIH protocol 09-EI-0075, Pilot Study for the Evaluation of Finasteride in the Treatment of Chronic Central Serous Chorioretinopathy, and demonstrated clinical improvement on finasteride treatment.
- The study requires 11 visits to the NEI outpatient clinic over 5 years, with visits occurring every 6 months. Participants will be screened with a medical history, physical examination, eye examination, and blood and urine tests.
- At each visit, participants will receive a supply of finasteride pills to take every day and will need to bring any leftover finasteride pills to the following visit.
- Participants will have eye examinations to test vision, eye pressure, eye movements, and retinal thickness. Additional eye examinations will evaluate the retina's sensitivity to light and study the blood vessels and flow of blood in the eyes.
- Blood and urine samples will be taken throughout the study.
- After the end of the study, participants may be able to speak to their doctor about continuing finasteride treatments with a prescription.
|Study Design:||Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Extension Study for the Evaluation of Finasteride in the Treatment of Chronic Central Serous Chorioretinopathy|
- Change in best-corrected visual acuity (BCVA) at two years compared to baseline [ Time Frame: will assess at 2 and 5 years ] [ Designated as safety issue: Yes ]
- Annual changes in BCVA, changes in subretinal fluid volume, leakage, plaque size, fundus autofluorescence patterns and microperimetry patterns, as well as changes in serum levels of testosterone and DHT and urine levels of cortisol from baseline [ Time Frame: will assess at 2 and 5 years ] [ Designated as safety issue: Yes ]
|Study Start Date:||October 2010|
|Estimated Study Completion Date:||October 2015|
|Primary Completion Date:||December 2012 (Final data collection date for primary outcome measure)|
Central serous chorioretinopathy (CSC) is a retinal disorder characterized by an accumulation of serous fluid under the retina. Although acute CSC tends to spontaneously resolve on its own with minimal sequelae, chronic CSC tends to persist and lead to irreversible visual loss. The pathogenesis of CSC is complex; however, systemic androgens have been implicated. A recent NIH protocol (09-EI-0075), Pilot Study for the Evaluation of Finasteride in the Treatment of Chronic Central Serous Chorioretinopathy, suggested that finasteride, an anti-androgen medication that is widely used in the treatment of various other conditions, may be efficacious as a treatment for chronic CSC. The objective of this study is to continue evaluation of participants in the completed NIH protocol 09-EI-0075 who clinically responded to treatment with finasteride.
Up to five participants previously enrolled in NIH protocol 09-EI-0075 who demonstrated clinical improvement on finasteride treatment.
This is a 5-year pilot extension study to allow participants who demonstrated clinical improvement with finasteride for chronic CSC to continue receiving finasteride as an off-label treatment. Study visits will occur every six months over the 5-year duration. Participants will receive finasteride when they have serous fluid present, unless deemed chronic non-responders (defined as serous fluid unchanged as compared to baseline or serous fluid stabilized with no further improvement while on finasteride treatment).
The primary outcome will be the change in best-corrected visual acuity (BCVA) at two years compared to baseline. Secondary outcome measures include the annual changes in BCVA, changes in subretinal fluid volume as measured on optical coherence tomography (OCT) (a 30% reduction in subretinal fluid from baseline is considered a treatment success by NEI standards), changes in leakage as observed on fluorescein angiography (FA), changes in plaque size as observed on indocyanine green angiography (ICG), changes in fundus autofluorescence patterns as observed on fundus autofluorescence (FAF) imaging, changes in microperimetry patterns, changes in serum levels of testosterone and dihydrotestosterone (DHT), as well as changes in urine levels of cortisol.
|United States, Maryland|
|National Institutes of Health Clinical Center, 9000 Rockville Pike|
|Bethesda, Maryland, United States, 20892|
|Principal Investigator:||Catherine Meyerle, M.D.||National Eye Institute (NEI)|