Oral vs IV Steroids for Acute Optic Neuritis

MedicalResearch.com Interview with:

Sarah A. Morrow MD, MS, FRCPC Associate Professor of Neurology Department of Clinical Neurological Sciences University of Western Ontario (Western)

Dr. Morrow

Sarah A. Morrow MD, MS, FRCPC
Associate Professor of Neurology
Department of Clinical Neurological Sciences
University of Western Ontario (Western)

MedicalResearch.com: What is the background for this study?

Response: Acute demyelinating optic neuritis, which presents with loss of vision and painful eye movements, is common in multiple sclerosis (MS) occurring 50% of persons with MS. High dose (≥ 1g) corticosteroids administered through an IV became the standard of practice after the landmark Optic Neuritis Treatment Trial as IV administration. However, in that study the IV dose of corticosteroids was much higher (1 gram daily) than the oral dose (1 mg/kg). Thus, it is not clear if IV administration is still better if equivalent doses are used orally. Oral administration is much more convenient for patients and less expensive, and previous studies showed that it is preferred by patients.

In this study, we asked the following question: are high dose (≥ 1000mg) IV corticosteroids superior to equivalent doses of oral corticosteroids for the acute treatment of optic neuritis?

We randomly assigned fifty-five cases of acute optic neuritis to 1000mg IV methylprednisolone or 1250mg oral prednisone daily for three days and compared recovery of their vision over the next 6 months. 

 MedicalResearch.com: What are the main findings?

Response: There were no differences at one and six months on any of our measures of visual function, both measures of optic nerve function and visual acuity. There was also no difference in the rate or type of side effects with either treatment.

MedicalResearch.com: What should readers take away from your report? 

Response: The use of oral high dose corticosteroids is as effective as high dose IV corticosteroids for acute

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Our study did not address other important clinical issues, such as who benefits the most from corticosteroid treatment when presenting with optic neuritis or the ideal timing of initiating treatment therapy. Additionally, there is little research, beyond the Optic Neuritis Treatment Trial regarding the long term benefit of corticosteroid treatment or whether high dose corticosteroids affects visual outcomes in the long run. 

Citations:

Morrow SA, Fraser JA, Day C, Bowman D, Rosehart H, Kremenchutzky M, Nicolle M. Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous CorticosteroidsA Randomized Clinical TrialJAMA Neurol. Published online March 05, 2018. doi:10.1001/jamaneurol.2018.0024

  

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