How is optic neuritis in multiple sclerosis (MS) treated?

Updated: Feb 21, 2019
  • Author: Fiona Costello, MD, FRCP; Chief Editor: Hampton Roy, Sr, MD  more...
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The ONTT showed that high-dose intravenous corticosteroids (250 mg administered every 6 hours for 3 days followed by oral prednisone [1 mg/kg/day] for 11 days) accelerated visual recovery relative to oral prednisone (1 mg/kg/day) and oral placebo. [13] However, intravenous corticosteroid treatment ultimately provided no measurable long-term benefits to vision. Subsequent studies have shown that the bioavailability of 1250 mg of oral prednisone (or 500 mg po bid) is comparable with 1 g of intravenous methylprednisolone (IVMP). [14, 26, 27]

Martinelli et al compared the efficacy and safety of 1000 mg IVMP versus 1000 mg oral methylprednisolone in patients experiencing MS relapse. [27] Both treatment groups demonstrated reduced gadolinium-enhancing MRI lesions over time with a noninferiority effect evident between the two routes of administration. [27] Patients in both treatment groups also showed significant improvement in Expanded Disability Status Scale (EDSS) scores in this study. [27] Burton et al compared the efficacy of oral versus intravenous steroids for MS relapses and reported no significant differences in clinical, radiological, or pharmacological outcomes between the groups. [28] Therefore, in clinical practice, high-dose oral steroids are often substituted for intravenous treatment, because it is a more convenient option for patients and their caregivers.

The decision to use or defer steroids in a patient with optic neuritis should weigh patient-related factors in the balance. In 2000, the Quality Standards Subcommittee of the American Academy of Neurology (AAN) reviewed the role of high-dose corticosteroids in the treatment of acute optic neuritis. The recommendation from the AAN was that treatment should be given with the intention to hasten recovery but not to improve ultimate visual outcome. Moreover, treatment decisions should take other non–evidence-based factors into account, such as quality of life, risk to the patient, and visual function in the fellow eye. [29]

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