• Oral or IV Corticosteroid Treatment of Optic Neuritis

    Written By: Lynda Seminara
    Selected By: Deepak P. Edward, MD

    Journal Highlights

    JAMA Neurology
    2018;75(6):690-696

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    Intravenous (IV) administration of corticosteroids is the standard of care for acute optic neuritis, but it can be costly and inconvenient. In an inves­tigator-masked randomized study, Morrow et al. sought to determine whether oral administration of a bioequivalent oral corticosteroid would be as effective as IV administration in the management of this condition. The authors found that recovery of vision was similar for the 2 treatment arms.

    Fifty-five adults presenting within 14 days of optic neuritis onset were enrolled in the study, which included a 6-month follow-up period. Partici­pants were assigned randomly (1:1) to receive IV methylprednisolone sodium succinate (1,000 mg) or oral predni­sone (1,250 mg) and were unmasked to treatment assignment. Each treatment was administered daily for 3 days. The selected oral dose was based on evidence of its bioequivalence to 1,000 mg of IV methylprednisolone in persons with multiple sclerosis.

    IV treatment was administered at a hospital outpatient infusion center—or, when possible, at a hospital outpatient infusion center for the first dose and at home for subsequent doses. Patients in the oral group received 75 tablets of 50-mg prednisone to be consumed at home (25 tablets per day). The primary outcome was recovery of the latency of the P100 component of the visual evoked potential at 6 months. Second­ary outcomes were P100 latency at 1 month and best-corrected visual acuity (BCVA) at 1 and 6 months.

    The final analysis cohort included 45 patients (23 in the IV group and 22 in the oral group).

    At 6 months, mean P100 latency had improved by 62.9 ms (from 181.9-119.0 ms) in the IV group and by 66.7 ms (from 200.5-133.8 ms) in the oral group. Also similar was P100 latency recovery at 1 month and BCVA at months 1 and 6, including low-contrast scores.

    The authors concluded that bio­equivalent oral doses of IV corticoste­roids appear to be suitable treatment for optic neuritis. As demonstrated in other studies, patients are likely to prefer the cost and convenience of oral medication.

    The original article can be found here.