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Optic neuritis treatment trial. One-year follow-up results.

Abstract

OBJECTIVE

To determine the efficacy of corticosteroids as treatment for acute demyelinative optic neuritis after completion of 1 year of patient follow-up in the Optic Neuritis Treatment Trial.

DESIGN

Randomized placebo controlled multicenter clinical trial.

SETTING

Fifteen university or hospital-based centers throughout the United States.

PATIENTS

Four hundred fifty-seven patients with acute demyelinative optic neuritis between 18 and 46 years of age.

INTERVENTION

Either intravenous methylprednisolone sodium succinate (250 mg every 6 hours) for 3 days followed by oral prednisone (1 mg/kg per day) for 11 days, oral prednisone (1 mg/kg per day) for 14 days, or oral placebo for 14 days. The first two regimens were followed by a short taper of corticosteroid therapy.

MAIN OUTCOME MEASURES

Visual acuity, visual field, contrast sensitivity, and color vision.

RESULTS

Visual acuity at 1 year was 20/40 or better in 95% of the placebo group, 94% of the intravenous group, and 91% of the oral prednisone group. Comparing each corticosteroid group with the placebo group, there were no statistically significant differences in the distributions of any of the four measures of visual function. Patients in the oral prednisone group suffered a higher rate of new attacks of optic neuritis than patients in either of the other two groups.

CONCLUSIONS

The visual benefit from treating acute optic neuritis with intravenous followed by oral corticosteroids is short term, limited to an accelerated rate of recovery. The decision whether to prescribe this regimen for optic neuritis, or to prescribe no treatment, must be made for each patient on an individual basis. Oral prednisone alone, in the dose range used in the Optic Neuritis Treatment Trial, should not be prescribed.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

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

    Source

    MeSH

    Acute Disease
    Administration, Oral
    Adolescent
    Adult
    Drug Therapy, Combination
    Female
    Follow-Up Studies
    Humans
    Infusions, Intravenous
    Male
    Methylprednisolone
    Middle Aged
    Optic Neuritis
    Prednisone
    Vision, Ocular

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    8512477

    Citation

    Beck, R W., and P A. Cleary. "Optic Neuritis Treatment Trial. One-year Follow-up Results." Archives of Ophthalmology (Chicago, Ill. : 1960), vol. 111, no. 6, 1993, pp. 773-5.
    Beck RW, Cleary PA. Optic neuritis treatment trial. One-year follow-up results. Arch Ophthalmol. 1993;111(6):773-5.
    Beck, R. W., & Cleary, P. A. (1993). Optic neuritis treatment trial. One-year follow-up results. Archives of Ophthalmology (Chicago, Ill. : 1960), 111(6), pp. 773-5.
    Beck RW, Cleary PA. Optic Neuritis Treatment Trial. One-year Follow-up Results. Arch Ophthalmol. 1993;111(6):773-5. PubMed PMID: 8512477.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Optic neuritis treatment trial. One-year follow-up results. AU - Beck,R W, AU - Cleary,P A, PY - 1993/6/1/pubmed PY - 1993/6/1/medline PY - 1993/6/1/entrez SP - 773 EP - 5 JF - Archives of ophthalmology (Chicago, Ill. : 1960) JO - Arch. Ophthalmol. VL - 111 IS - 6 N2 - OBJECTIVE: To determine the efficacy of corticosteroids as treatment for acute demyelinative optic neuritis after completion of 1 year of patient follow-up in the Optic Neuritis Treatment Trial. DESIGN: Randomized placebo controlled multicenter clinical trial. SETTING: Fifteen university or hospital-based centers throughout the United States. PATIENTS: Four hundred fifty-seven patients with acute demyelinative optic neuritis between 18 and 46 years of age. INTERVENTION: Either intravenous methylprednisolone sodium succinate (250 mg every 6 hours) for 3 days followed by oral prednisone (1 mg/kg per day) for 11 days, oral prednisone (1 mg/kg per day) for 14 days, or oral placebo for 14 days. The first two regimens were followed by a short taper of corticosteroid therapy. MAIN OUTCOME MEASURES: Visual acuity, visual field, contrast sensitivity, and color vision. RESULTS: Visual acuity at 1 year was 20/40 or better in 95% of the placebo group, 94% of the intravenous group, and 91% of the oral prednisone group. Comparing each corticosteroid group with the placebo group, there were no statistically significant differences in the distributions of any of the four measures of visual function. Patients in the oral prednisone group suffered a higher rate of new attacks of optic neuritis than patients in either of the other two groups. CONCLUSIONS: The visual benefit from treating acute optic neuritis with intravenous followed by oral corticosteroids is short term, limited to an accelerated rate of recovery. The decision whether to prescribe this regimen for optic neuritis, or to prescribe no treatment, must be made for each patient on an individual basis. Oral prednisone alone, in the dose range used in the Optic Neuritis Treatment Trial, should not be prescribed. SN - 0003-9950 UR - https://www.unboundmedicine.com/medline/citation/8512477/full_citation L2 - https://jamanetwork.com/journals/jamaophthalmology/fullarticle/vol/111/pg/773 DB - PRIME DP - Unbound Medicine ER -