This randomized clinical trial compared the efficacy of high-dose IV corticosteroids with a bioequivalent dose of oral corticosteroids for the treatment of acute optic neuritis.

Study design

The single-masked study included 45 patients between the ages of 18 and 64 who presented within 14 days of acute optic neuritis onset. Patients had a BCVA of 20/40 or worse and corticosteroids were deemed necessary by the treating physician.

Patients were randomized to 3 days of high-dose IV methylprednisolone sodium succinate (1000 mg) or oral prednisone (1250 mg).

Outcomes

At months 1 and 6, investigators found no significant differences between groups in recovery on visual evoked potential P100 latency, BCVA, or low-contrast BCVA (1.25% and 2.5%).

Limitations

The study does not explore who will benefit from corticosteroid treatment or the ideal timing for therapy initiation. There may have been a referral bias; if the treating physician decided that IV (or oral) corticosteroids were more appropriate, the participant would not have been screened for the study.

Clinical significance

Bioequivalent doses of oral corticosteroids may be used as an alternative to IV corticosteroids to treat acute optic neuritis. An oral regimen may be more cost-effective and convenient for patients.