A short course of oral mifepristone may reduce or improve subretinal fluid and improve best-corrected visual acuity (BCVA) in patients with chronic or recurrent central serous chorioretinopathy (CSC), said Roger Goldberg, MD, MBA, with Bay Area Retina Associates.
There are numerous risk factors for CSC, including being Type A personality, systemic hypertension, Cushing syndrome, pregnancy, organ transplantation, allergic respiratory disease, or autoimmune disorders.
Mifepristone is a potent, glucocorticoid steroid antagonist and because CSC is associated with either excessive endogenous cortisol and epinephrine levels, or excessive exogenous cortisol that affects the autoregulation of choroid circulation, mifepristone is a natural possibility to consider for treatment of CSC.
"It is thought that excess cortisol levels in pre-disposed individuals affects the choroidal circulation and autoregulation," Dr. Goldberg said. "This suggests that if we can inhibit or block the effect of steroids, we might be able to offer a treatment to these patients."
Mifepristone binds to cystolic glucosteroid receptors and prevents gene expression, but it is also a progesterone antagonist. The compound has a high oral bioavailability with an acceptable side effect profile, Dr. Goldberg said
In the U.S., the compound has been approved for use in two separate indications, one as an abortifacient (RU-486) in a lower dose (200 mg) and for Cushing syndrome with a 300 mg dose.
Dr. Goldberg is an investigator for Corcept Therapeutics.