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


METHODS
Randomized placebo controlled multicenter clinical trial.


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


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


METHODS
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.


METHODS
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.
Beck
R W
RW
Department of Ophthalmology, University of South Florida College of Medicine, Tampa 33612.
Cleary
P A
PA
D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009902:Optic Neuritis / Q000188:drug therapy*; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use*; D014785:Vision, Ocular
D011241:Prednisone; D008775:Methylprednisolone