OPTIC NEURITIS TREATMENT TRIAL - ONE-YEAR FOLLOW-UP RESULTS

- Objective.-To determine the efficacy of corticosteroids as treatment for acute demyelinative optic neuritis after completion of 1 year of patient follow-up in the Optic Neuritis Treatment Trial. Design.-Rando mized placebo controlled multicenter clinical trial. Setting.-Fifteen university or hospital-based centers throughout the United States. Pat ients.-Four hundred fifty-seven patients with acute demyelinative opti c neuritis between 18 and 46 years of age. Interventions.-Either intra venous methylprednisolone sodium succinate (250 mg every 6 hours) for 3 days followed by oral prednisone (1 mg/kg per day) for 11 days, oral prednisone (1 mg/kg per day) for 14 days, or oral placebo for 14 days . The first two regimens were followed by a short taper of corticoster oid therapy. Main Outcome Measures.-Visual acuity, visual field, contr ast sensitivity, and color vision. Results.-Visual acuity at 1 year wa s 20/40 or better in 95% of the placebo group, 94% of the intravenous group, and 91% of the oral prednisone group. Comparing each corticoste roid group with the placebo group, there were no statistically signifi cant differences in the distributions of any of the four measures of v isual function. Patients in the oral prednisone group suffered a highe r rate of new attacks of optic neuritis than patients in either of the other two groups. Conclusions.-The visual benefit from treating acute optic neuritis with intravenous followed by oral corticosteroids is s hort term, limited to an accelerated rate of recovery. The decision wh ether to prescribe this regimen for optic neuritis, or to prescribe no treatment, must be made for each patient on an individual basis. Oral prednisone alone, in the dose range used in the Optic Neuritis Treatm ent Trial, should not be prescribed.