The efficacy of bioequivalent oral corticosteroids is similar to intravenous (IV) corticosteroids for treating acute optic neuritis, making bioequivalent oral corticosteroids an acceptable alternative to standard IV steroid hormonal therapy, according to findings from a randomized clinical trial published in JAMA Neurology.
Investigators enrolled and screened 55 adult patients who presented to a single tertiary care center within 14 days of acute optic neuritis onset. Participants had best-corrected visual acuity of 20/40 or worse. Blinded investigators randomly assigned participants 1:1 to either a 1000-mg IV dose of methylprednisolone sodium succinate (n=23) or a 1250-mg dose of oral prednisone (n=22). The primary outcome was composed of recovery of the visual evoked potential P100 component latency in the affected eye at 6 months.
There were no significant differences between the IV and oral corticosteroid groups in terms of P100 latency at 6 months’ recovery (62.9 milliseconds [mean (SD), 181.9 (53.6)-119.0 (16.5) milliseconds] vs 66.7 milliseconds [mean (SD), 200.5 (67.2)-133.8 (31.5) milliseconds], respectively; P =.07). The secondary outcome of P100 latency recovery at 1 month was also not significantly different between the IV and oral corticosteroid groups (41.8-140.1 [28.5] milliseconds vs 55.1-145.4 [41.5] milliseconds, respectively; P =.75). In addition, 6-month best-corrected visual acuity was not significantly greater with oral vs IV corticosteroids (P =.30).
This small study was unable to identify the most appropriate patients for corticosteroid therapy or the ideal timing of therapy initiation. Also, considering patients from this study were admitted to a single center in Canada, the findings may not generalize to patients presenting at other medical centers.
Although there were no significant efficacy differences between oral and IV corticosteroids in this study, the advantages of oral prednisone include “being less expensive and more convenient to access and administer and [being] preferred by patients to IV methylprednisolone.”
Morrow SA, Fraser JA, Day C, et al. Effect of treating acute optic neuritis with bioequivalent oral vs intravenous corticosteroids: a randomized clinical trial [published online March 5, 2018]. JAMA Neurol. doi:10.1001/jamaneurol.2018.0024