During the 1980s, the use of corticosteroids in the treatment of acute demyelinating optic neuritis was considered a controversial subject. The Optic Neuritis Treatment Trial (ONTT), published in 1992, was designed to resolve this controversy. This study enrolled 457 patients with acute demyelinating optic neuritis between 18 and 46 years of age from 15 different centers. Patient were divided into treatment 3 groups: (1) IV methylprednisolone 250 mg Q6hrs x 3 days followed by PO prednisone 1 mg/kg/day x 11 days, (2) PO prednisone 1 mg/kg/day x 14 days, and (3) placebo x 14 days. The study found that IV steroid use led to faster vision recovery compared to placebo.
However, despite this short-term benefit from IV steroids, by 1 year follow up there was no significant difference in visual acuity between IV steroid treatment and placebo treatment groups.
Regardless, IV high-dose steroids became the standard of care for acute optic neuritis. Retrospectively looking at this data, it was known that the IV doses of methylprednisolone used in Group 1 were not bioequivalent to the oral doses of prednisone used in Group 2. Hence, another study was needed to compare bioequivalent doses.
In 2018, another similar study was published titled “Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids”. It compared bioequivalent doses of high dose IV vs PO steroids for 3 days (i.e. 1000 mg IV methylprednisolone vs 1250 mg PO prednisone). This study did not find any significantly different outcomes at both 1-month or 6-month follow-ups.
Hence, the formulation of steroids in the management of demyelinating optic neuritis is not as important as ensuring a high dose is provided.
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References:
- Beck RW, Cleary PA, Anderson MM, et al. A Randomized, Controlled Trial of Corticosteroids in the Treatment of Acute Optic Neuritis. 1992;326:581-588.
- Sarah A. Morrow, J. Alexander Fraser, Chad Day, Denise Bowman, Heather Rosehart, Marcelo Kremenchutzky, and Michael Nicolle, Effect of Treating Acute Optic Neuritis With Bioequivalent Oral vs Intravenous Corticosteroids; A Randomized Clinical Trial JAMA Neurol. 2018 Jun; 75(6): 690–696.
