Intravenous methylprednisolone versus oral prednisone for initial attacks of optic neuritis, A review of evidence

Objective

To review current available evidence that addresses the question regarding the efficacy of intravenous methylprednisolone and oral-prednisone treatment regimens in improving vision among optic-neuritis patients.

Methods

A literature search for randomized controlled trials on the treatment of optic neuritis in adults using steroids was conducted. A total of 23 studies were identified in the search. Of these, the Optic Neuritis Treatment Trial (ONTT) was identified as the largest multicenter, randomized controlled trial that evaluated the effect of steroids in the treatment of optic neuritis in adults. The initial article regarding the results of this landmark study published in 1992 and follow-up reports focusing on the five-year and ten-year visual outcomes published in 1997 and 2004 were appraised for this review.

Results

Treatment with high dose intravenous methylprednisolone followed by oral prednisone produced short-term accelerated visual recovery but provided no long-term benefit to vision. Most patients retained good to excellent vision following an attack of optic neuritis regardless of treatment received. A significantly increased risk of recurrence of optic neuritis in either eye (19%) was noted in the oral-prednisone treatment group. There were no significant differences among the treatment groups in the risk of development of clinically definite multiple sclerosis.

Conclusion

Intravenous methylprednisolone followed by oral prednisone may be considered as treatment for patients with acute optic neuritis in whom there is a need to speed up recovery of vision. Considering that the use of oral prednisone alone was associated with an increased risk of recurrence of optic neuritis in either eye, no treatment is an option.

Keywords: Methylprednisolone, Prednisone, Optic neuritis, Multiple sclerosis