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A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group.

Abstract

BACKGROUND AND METHODS

The use of corticosteroids to treat optic neuritis is controversial. At 15 clinical centers, we randomly assigned 457 patients with acute optic neuritis to receive oral prednisone (1 mg per kilogram of body weight per day) for 14 days; intravenous methylprednisolone (1 g per day) for 3 days, followed by oral prednisone (1 mg per kilogram per day) for 11 days; or oral placebo for 14 days. Visual function was assessed over a six-month follow-up period.

RESULTS

Visual function recovered faster in the group receiving intravenous methylprednisolone than in the placebo group; this was particularly true for the reversal of visual-field defects (P = 0.0001). Although the differences between the groups decreased with time, at six months the group that received intravenous methylprednisolone still had slightly better visual fields (P = 0.054), contrast sensitivity (P = 0.026), and color vision (P = 0.033) but not better visual acuity (P = 0.66). The outcome in the oral-prednisone group did not differ from that in the placebo group. In addition, the rate of new episodes of optic neuritis in either eye was higher in the group receiving oral prednisone, but not the group receiving intravenous methylprednisolone, than in the placebo group (relative risk for oral prednisone vs. placebo, 1.79; 95 percent confidence interval, 1.08 to 2.95).

CONCLUSIONS

Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis and results in slightly better vision at six months. Oral prednisone alone, as prescribed in this study, is an ineffective treatment and increases the risk of new episodes of optic neuritis.

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  • Authors+Show Affiliations

    ,

    Department of Ophthalmology, University of South Florida College of Medicine, Tampa 33612.

    , , , , , , , ,

    Source

    The New England journal of medicine 326:9 1992 Feb 27 pg 581-8

    MeSH

    Acute Disease
    Administration, Oral
    Adolescent
    Adult
    Color Perception
    Female
    Follow-Up Studies
    Humans
    Injections, Intravenous
    Male
    Methylprednisolone
    Middle Aged
    Multiple Sclerosis
    Optic Neuritis
    Patient Compliance
    Prednisone
    Recurrence
    Visual Acuity
    Visual Fields

    Pub Type(s)

    Clinical Trial
    Comparative Study
    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    1734247

    Citation

    Beck, R W., et al. "A Randomized, Controlled Trial of Corticosteroids in the Treatment of Acute Optic Neuritis. the Optic Neuritis Study Group." The New England Journal of Medicine, vol. 326, no. 9, 1992, pp. 581-8.
    Beck RW, Cleary PA, Anderson MM, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. N Engl J Med. 1992;326(9):581-8.
    Beck, R. W., Cleary, P. A., Anderson, M. M., Keltner, J. L., Shults, W. T., Kaufman, D. I., ... Miller, N. R. (1992). A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. The New England Journal of Medicine, 326(9), pp. 581-8.
    Beck RW, et al. A Randomized, Controlled Trial of Corticosteroids in the Treatment of Acute Optic Neuritis. the Optic Neuritis Study Group. N Engl J Med. 1992 Feb 27;326(9):581-8. PubMed PMID: 1734247.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. A1 - Beck,R W, AU - Cleary,P A, AU - Anderson,M M,Jr AU - Keltner,J L, AU - Shults,W T, AU - Kaufman,D I, AU - Buckley,E G, AU - Corbett,J J, AU - Kupersmith,M J, AU - Miller,N R, PY - 1992/3/8/pubmed PY - 2001/3/28/medline PY - 1992/3/8/entrez SP - 581 EP - 8 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 326 IS - 9 N2 - BACKGROUND AND METHODS: The use of corticosteroids to treat optic neuritis is controversial. At 15 clinical centers, we randomly assigned 457 patients with acute optic neuritis to receive oral prednisone (1 mg per kilogram of body weight per day) for 14 days; intravenous methylprednisolone (1 g per day) for 3 days, followed by oral prednisone (1 mg per kilogram per day) for 11 days; or oral placebo for 14 days. Visual function was assessed over a six-month follow-up period. RESULTS: Visual function recovered faster in the group receiving intravenous methylprednisolone than in the placebo group; this was particularly true for the reversal of visual-field defects (P = 0.0001). Although the differences between the groups decreased with time, at six months the group that received intravenous methylprednisolone still had slightly better visual fields (P = 0.054), contrast sensitivity (P = 0.026), and color vision (P = 0.033) but not better visual acuity (P = 0.66). The outcome in the oral-prednisone group did not differ from that in the placebo group. In addition, the rate of new episodes of optic neuritis in either eye was higher in the group receiving oral prednisone, but not the group receiving intravenous methylprednisolone, than in the placebo group (relative risk for oral prednisone vs. placebo, 1.79; 95 percent confidence interval, 1.08 to 2.95). CONCLUSIONS: Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis and results in slightly better vision at six months. Oral prednisone alone, as prescribed in this study, is an ineffective treatment and increases the risk of new episodes of optic neuritis. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/1734247/full_citation L2 - https://www.nejm.org/doi/10.1056/NEJM199202273260901?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=www.ncbi.nlm.nih.gov DB - PRIME DP - Unbound Medicine ER -