• IV or Oral Corticosteroids for Acute Optic Neuritis

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

    Journal Highlights

    JAMA Neurology
    Published online March 5, 2018

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    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.