Effect of altering the regime of oral rifampicin therapy in the treatment of persistent central serous chorioretinopathy

Abstract

Objective: To study the effect of reducing the duration of rifampicin therapy in the treatment of Chronic Central Serous Chorioretinopathy.
 Methods: This is interventional study conducted in Layton Rahmatullah Benevolent Trust, Free Base Eye Hospital Korangi, Karachi from February 2017 - December 2018. This randomized controlled comparative study included two groups, Groups-A comprised of 48 eyes of 40 cases with Chronic Central Serous Chorioretinopathy who were given reduced dose of oral rifampicin i.e. 600mg for one month, and Group-B consisted of 43 eyes of 40 controls with Chronic Central Serous Chorioretinopathy who were given reduced dose of oral rifampicin i.e. 300mg once daily for three months as previously stated in literature. To access the effect of therapy in both the groups, pre-treatment visual acuity on the logMAR and Optical Coherent Tomography (OCT, Heidelberg spectralis) for CMT were performed and repeated on the 1st and 3rd month post-treatment. Patients were also followed for 6 months to access any recurrence.
 Results: On comparing the two groups, Group-A had improvement in VA and CMT after one month therapy of Rifampicin, Pre-treatment mean VA in Group-A was 0.85 ± 0.19 as compared to the pre-treatment mean VA in Group-B i.e. 0.74+/- 0.208, while the pre-treatment mean CMT was 609.0 ± 178.29 µm in Group-A, and 600.0 +/- 155.09 µm in Group-B respectively. After 1 month of therapy, the visual status, and CMT in Group-A was 0.29+/- 0.21 and 311.6 +/- 89.9, while Group-B, VA was 0.598 +/- 0.23 (p value 0.001%) and CMT was 512.30 +/- 148.37 (p-value 0.001%). Rifampicin was continued in Group-B till three months, and patients were re-accessed but there was no difference in VA and CMT statically. During the 3rd and 6th months of follow up no relapses were reported.
 Conclusion: This comparative study showed that the group receiving oral rifampicin 600mg for one month showed better outcome at one month and third month than the group receiving oral rifampicin at a dose of 300mg once daily for three months. This gives a better compliance and lower the risk of drug induced side effects.
 doi: https://doi.org/10.12669/pjms.35.6.990
 How to cite this:Loya H, Ghoghari H, Rizvi SF, Khan A. Effect of altering the regime of oral rifampicin therapy in the treatment of persistent central serous chorioretinopathy. Pak J Med Sci. 2019;35(6):1687-1690. doi: https://doi.org/10.12669/pjms.35.6.990
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Using oral Rifampin to treat acute central serous Chorioretinopathy: a randomized placebo-controlled clinical trial ‎

“…Contrastingly, Golshahi et al found that a month-long administration of 200 mg ketoconazole per day did not surpass the effects of placebo treatment [24]. A few studies reported resolution of the subretinal fluid in patients with CSC following the administration of oral rifampin [27][28][29]. Rifampin is a cytochrome P450 and 3A4 inducer and thus increases the processing of endogenous steroids through the induction of hepatic metabolism [34,35].…”

“…Given that corticosteroids are involved in CSC formation, glucocorticoid inhibition has been recommended as a possible therapeutic method [16][17][18][19][20][21][22]. Small-scale case series support the role of systemic anti-corticosteroid agents, including mifepristone, ketoconazole, finasteride, and rifampin, in the treatment of CSC [6,[23][24][25][26][27]. A few studies recently examined the impacts of mineralocorticoid receptor antagonists on CSC and endorsed the use of these agents in treating the disease [28][29][30], but these medications have not been included in the treatment protocols for CSC.…”

Comparative efficacy of treatments for chronic central serous chorioretinopathy: A systematic review with network meta‐analyses

“…Two studies investigated efficacy of other types of therapies. Loya et al (2019) studied the effect of oral rifampicin 600 mg daily for 1 month and compared with a group who received oral rifampicin 300 mg daily for 3 months. The authors found no differences between these two dosages in terms of efficacy (Loya et al, 2019).…”

“…treatment of low‐fluence PDT at 30% vs. 40% vs. 50%). In addition, Loya et al (2019) were also excluded from the analyses since none of the other studies had a rifampicin treatment group, Loya et al (2019) did not have another treatment or control study group, and hence, the network did not reach out to this study. In total, 16 studies were eligible for the quantitative analysis.…”

“…Loya et al (2019) studied the effect of oral rifampicin 600 mg daily for 1 month and compared with a group who received oral rifampicin 300 mg daily for 3 months. The authors found no differences between these two dosages in terms of efficacy (Loya et al, 2019). Shinojima et al (2017) studied oral antioxidant supplementation and compared this to a placebo group.…”