IV or Oral Corticosteroids for Acute Optic Neuritis
Published online March 5, 2018
Morrow et al. compared visual recovery after treatment of acute optic neuritis (ON) with either a high-dose intravenous (IV) corticosteroid or a bioequivalent oral corticosteroid. They found no significant difference in outcomes.
This randomized trial was conducted over several years at a tertiary care center in Canada and included a 6-month follow-up period. Assessors were masked with respect to treatment assignment. Eligible patients were adults aged 18 to 64 years who presented within 14 days of onset of unilateral demyelinating ON, had no prior history of ON in the affected eye, and had no evidence of recovery by the time of randomization. Other criteria were best-corrected visual acuity (BCVA) of 20/40 or worse and a documented need for corticosteroid treatment.
Of the 89 candidates screened, 55 were enrolled and received IV methylprednisolone sodium succinate (1,000 mg) or oral prednisone (1,250 mg) daily for 3 days. Visual evoked potentials were measured, and the primary outcome was recovery of the VEP P100 latency at 6 months. Secondary outcomes were P100 latency at month 1 and BCVA at months 1 and 6.
Forty-five patients completed the analyses (23 in the IV group, 22 in the oral group). By 6 months, P100 latency had improved to 62.9 ms (from 181.9 ms) in the IV group and 66.7 ms (from 200.5 ms) in the oral group (p = .07). There were no significant differences in P100 latency recovery at 1 month or BCVA recovery at 1 or 6 months, including low-contrast BCVA. In addition, there was no significant difference in adverse events between the groups.
The original article can be found here.