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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):581-8NEJM

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.

Authors+Show Affiliations

Department of Ophthalmology, University of South Florida College of Medicine, Tampa 33612.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

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 - http://www.nejm.org/doi/full/10.1056/NEJM199202273260901?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -