A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis

Roy W. Beck, Patricia A. Cleary, Malcolm M. Anderson, John L. Keltner, William T. Shults, David I. Kaufman, Edward G. Buckley, James J. Corbett, Mark J. Kupersmith, Neil R. Miller, Peter J. Savino, John R. Guy, Jonathan D. Trobe, John A. Mccrary, Craig H. Smith, Georgia A. Chrousos, H. Stanley Thompson, Barrett J. Katz, Michael C. Brodsky, James A. GoodwinConstance W. Atwell

Research output: Contribution to journalArticle

895 Citations (Scopus)

Abstract

Background and Methods. The use of corticosteroids to treat optic neuritis is controversial. At 15 clinical centers, we randomly assigned 457 patients with acute optic neuritis to receive oral prednisone (1 mg per kilogram of body weight per day) for 14 days; intravenous methyl-prednisolone (1 g per day) for 3 days, followed by oral prednisone (1 mg per kilogram per day) for 11 days; or oral placebo for 14 days. Visual function was assessed over a six-month follow-up period. Results. Visual function recovered faster in the group receiving intravenous methylprednisolone than in the placebo group; this was particularly true for the reversal of visual-field defects (P = 0.0001). Although the differences between the groups decreased with time, at six months the group that received intravenous methylprednisolone still had slightly better visual fields (P = 0.054), contrast sensitivity (P = 0.026), and color vision (P = 0.033) but not better visual acuity (P = 0.66). The outcome in the oral-prednisone group did not differ from that in the placebo group. In addition, the rate of new episodes of optic neuritis in either eye was higher in the group receiving oral prednisone, but not the group receiving intravenous methylprednisolone, than in the placebo group (relative risk for oral prednisone vs. placebo, 1.79; 95 percent confidence interval, 1.08 to 2.95). Conclusions. Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis and results in slightly better vision at six months. Oral prednisone alone, as prescribed in this study, is an ineffective treatment and increases the risk of new episodes of optic neuritis.

Original languageEnglish (US)
Pages (from-to)581-588
Number of pages8
JournalNew England Journal of Medicine
Volume326
Issue number9
StatePublished - Feb 27 1992

Fingerprint

Optic Neuritis
Prednisone
Adrenal Cortex Hormones
Randomized Controlled Trials
Methylprednisolone
Placebos
Visual Fields
Therapeutics
Color Vision
Contrast Sensitivity
Prednisolone
Visual Acuity
Body Weight
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Beck, R. W., Cleary, P. A., Anderson, M. M., Keltner, J. L., Shults, W. T., Kaufman, D. I., ... Atwell, C. W. (1992). A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. New England Journal of Medicine, 326(9), 581-588.

A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. / Beck, Roy W.; Cleary, Patricia A.; Anderson, Malcolm M.; Keltner, John L.; Shults, William T.; Kaufman, David I.; Buckley, Edward G.; Corbett, James J.; Kupersmith, Mark J.; Miller, Neil R.; Savino, Peter J.; Guy, John R.; Trobe, Jonathan D.; Mccrary, John A.; Smith, Craig H.; Chrousos, Georgia A.; Thompson, H. Stanley; Katz, Barrett J.; Brodsky, Michael C.; Goodwin, James A.; Atwell, Constance W.

In: New England Journal of Medicine, Vol. 326, No. 9, 27.02.1992, p. 581-588.

Research output: Contribution to journalArticle

Beck, RW, Cleary, PA, Anderson, MM, Keltner, JL, Shults, WT, Kaufman, DI, Buckley, EG, Corbett, JJ, Kupersmith, MJ, Miller, NR, Savino, PJ, Guy, JR, Trobe, JD, Mccrary, JA, Smith, CH, Chrousos, GA, Thompson, HS, Katz, BJ, Brodsky, MC, Goodwin, JA & Atwell, CW 1992, 'A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis', New England Journal of Medicine, vol. 326, no. 9, pp. 581-588.
Beck RW, Cleary PA, Anderson MM, Keltner JL, Shults WT, Kaufman DI et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. New England Journal of Medicine. 1992 Feb 27;326(9):581-588.
Beck, Roy W. ; Cleary, Patricia A. ; Anderson, Malcolm M. ; Keltner, John L. ; Shults, William T. ; Kaufman, David I. ; Buckley, Edward G. ; Corbett, James J. ; Kupersmith, Mark J. ; Miller, Neil R. ; Savino, Peter J. ; Guy, John R. ; Trobe, Jonathan D. ; Mccrary, John A. ; Smith, Craig H. ; Chrousos, Georgia A. ; Thompson, H. Stanley ; Katz, Barrett J. ; Brodsky, Michael C. ; Goodwin, James A. ; Atwell, Constance W. / A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. In: New England Journal of Medicine. 1992 ; Vol. 326, No. 9. pp. 581-588.
@article{38518e0090f1472484c89fbd845cc391,
title = "A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis",
abstract = "Background and Methods. The use of corticosteroids to treat optic neuritis is controversial. At 15 clinical centers, we randomly assigned 457 patients with acute optic neuritis to receive oral prednisone (1 mg per kilogram of body weight per day) for 14 days; intravenous methyl-prednisolone (1 g per day) for 3 days, followed by oral prednisone (1 mg per kilogram per day) for 11 days; or oral placebo for 14 days. Visual function was assessed over a six-month follow-up period. Results. Visual function recovered faster in the group receiving intravenous methylprednisolone than in the placebo group; this was particularly true for the reversal of visual-field defects (P = 0.0001). Although the differences between the groups decreased with time, at six months the group that received intravenous methylprednisolone still had slightly better visual fields (P = 0.054), contrast sensitivity (P = 0.026), and color vision (P = 0.033) but not better visual acuity (P = 0.66). The outcome in the oral-prednisone group did not differ from that in the placebo group. In addition, the rate of new episodes of optic neuritis in either eye was higher in the group receiving oral prednisone, but not the group receiving intravenous methylprednisolone, than in the placebo group (relative risk for oral prednisone vs. placebo, 1.79; 95 percent confidence interval, 1.08 to 2.95). Conclusions. Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis and results in slightly better vision at six months. Oral prednisone alone, as prescribed in this study, is an ineffective treatment and increases the risk of new episodes of optic neuritis.",
author = "Beck, {Roy W.} and Cleary, {Patricia A.} and Anderson, {Malcolm M.} and Keltner, {John L.} and Shults, {William T.} and Kaufman, {David I.} and Buckley, {Edward G.} and Corbett, {James J.} and Kupersmith, {Mark J.} and Miller, {Neil R.} and Savino, {Peter J.} and Guy, {John R.} and Trobe, {Jonathan D.} and Mccrary, {John A.} and Smith, {Craig H.} and Chrousos, {Georgia A.} and Thompson, {H. Stanley} and Katz, {Barrett J.} and Brodsky, {Michael C.} and Goodwin, {James A.} and Atwell, {Constance W.}",
year = "1992",
month = "2",
day = "27",
language = "English (US)",
volume = "326",
pages = "581--588",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "9",

}

TY - JOUR

T1 - A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis

AU - Beck, Roy W.

AU - Cleary, Patricia A.

AU - Anderson, Malcolm M.

AU - Keltner, John L.

AU - Shults, William T.

AU - Kaufman, David I.

AU - Buckley, Edward G.

AU - Corbett, James J.

AU - Kupersmith, Mark J.

AU - Miller, Neil R.

AU - Savino, Peter J.

AU - Guy, John R.

AU - Trobe, Jonathan D.

AU - Mccrary, John A.

AU - Smith, Craig H.

AU - Chrousos, Georgia A.

AU - Thompson, H. Stanley

AU - Katz, Barrett J.

AU - Brodsky, Michael C.

AU - Goodwin, James A.

AU - Atwell, Constance W.

PY - 1992/2/27

Y1 - 1992/2/27

N2 - Background and Methods. The use of corticosteroids to treat optic neuritis is controversial. At 15 clinical centers, we randomly assigned 457 patients with acute optic neuritis to receive oral prednisone (1 mg per kilogram of body weight per day) for 14 days; intravenous methyl-prednisolone (1 g per day) for 3 days, followed by oral prednisone (1 mg per kilogram per day) for 11 days; or oral placebo for 14 days. Visual function was assessed over a six-month follow-up period. Results. Visual function recovered faster in the group receiving intravenous methylprednisolone than in the placebo group; this was particularly true for the reversal of visual-field defects (P = 0.0001). Although the differences between the groups decreased with time, at six months the group that received intravenous methylprednisolone still had slightly better visual fields (P = 0.054), contrast sensitivity (P = 0.026), and color vision (P = 0.033) but not better visual acuity (P = 0.66). The outcome in the oral-prednisone group did not differ from that in the placebo group. In addition, the rate of new episodes of optic neuritis in either eye was higher in the group receiving oral prednisone, but not the group receiving intravenous methylprednisolone, than in the placebo group (relative risk for oral prednisone vs. placebo, 1.79; 95 percent confidence interval, 1.08 to 2.95). Conclusions. Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis and results in slightly better vision at six months. Oral prednisone alone, as prescribed in this study, is an ineffective treatment and increases the risk of new episodes of optic neuritis.

AB - Background and Methods. The use of corticosteroids to treat optic neuritis is controversial. At 15 clinical centers, we randomly assigned 457 patients with acute optic neuritis to receive oral prednisone (1 mg per kilogram of body weight per day) for 14 days; intravenous methyl-prednisolone (1 g per day) for 3 days, followed by oral prednisone (1 mg per kilogram per day) for 11 days; or oral placebo for 14 days. Visual function was assessed over a six-month follow-up period. Results. Visual function recovered faster in the group receiving intravenous methylprednisolone than in the placebo group; this was particularly true for the reversal of visual-field defects (P = 0.0001). Although the differences between the groups decreased with time, at six months the group that received intravenous methylprednisolone still had slightly better visual fields (P = 0.054), contrast sensitivity (P = 0.026), and color vision (P = 0.033) but not better visual acuity (P = 0.66). The outcome in the oral-prednisone group did not differ from that in the placebo group. In addition, the rate of new episodes of optic neuritis in either eye was higher in the group receiving oral prednisone, but not the group receiving intravenous methylprednisolone, than in the placebo group (relative risk for oral prednisone vs. placebo, 1.79; 95 percent confidence interval, 1.08 to 2.95). Conclusions. Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis and results in slightly better vision at six months. Oral prednisone alone, as prescribed in this study, is an ineffective treatment and increases the risk of new episodes of optic neuritis.

UR - http://www.scopus.com/inward/record.url?scp=0026586019&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026586019&partnerID=8YFLogxK

M3 - Article

C2 - 1734247

AN - SCOPUS:0026586019

VL - 326

SP - 581

EP - 588

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 9

ER -