A comparative study of visual outcome in patients with optic neuritis treated with five or seven days of intravenous corticosteroid treatment

• Published in: Multiple sclerosis and related disorders 2023-07, Vol.75, p.104737-104737, Article 104737
• Main Authors: Silva, Guilherme Diogo, Terrim, Sara, Falcão, Fernando Cavalcantide Sá e Benevides, Falcão, Maria Alice Pimentel, Chaves, Cleuber Esteves, Apóstolos-Pereira, Samira, Fortini, Ida, Gonçalves, Márcia Rúbia Rodrigues, Comerlatti, Luiz Roberto, Castro, Luiz Henrique Martins, Callegaro, Dagoberto, Monteiro, Mário Luiz Ribeiro
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Brazil; Humans; Methylprednisolone; Optic Neuritis - diagnosis; Optic Neuritis - drug therapy; Retrospective Studies; Treatment Outcome; Vision Disorders - drug therapy; Vision Disorders - etiology; Young Adult
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2023.104737

•We found similar frequency of visual impairment at 6–12 months in patients with ON treated with 5-day or 7-day duration of 1 g/d intravenous methylprednisolone treatment (IVMPT).•Corticosteroids comprise a genomic and non-genomic effect.•The ceiling effect of IVMP treatment may occur because the genomic effect is already in place at five days and, hence, the non-genomic effect does not provide additional benefit. Optic neuritis (ON), a major cause of visual impairment in young adults, is generally associated with rapid visual recovery when treated with intravenous methylprednisolone treatment (IVMPT). However, the optimal duration of such treatment is unknown, ranging from three to seven days in clinical practice. We aimed to compare the visual recovery in patients treated with 5-day or 7-day duration IVMPT. We performed a retrospective cohort study of consecutive patients with ON in São Paulo, Brazil, from 2016 to 2021. We compared the proportion of participants with visual impairment in 5-day and 7-day treatment schedules at discharge, at 1 month and between 6 and 12 months after the diagnosis of ON. The findings were adjusted to age, severity of the visual impairment, co-intervention with plasma exchange, time from symptom onset to IVMPT and the etiology of the ON to mitigate indication bias. We included 73 patients with ON treated with 5 or 7-day duration of 1 g/d intravenous methylprednisolone therapy. Visual impairment at 6–12 months in the 5-day or the 7-day treatment groups was similar (57% x 59%, p > 0.9, Odds Ratio 1.03 [95% CI 0.59–1.84]). The results were similar after adjusting for prognostic variables and when observed at different time points. Visual recovery is similar in patients treated with 5-day and 7-day duration treatments of 1 g/day intravenous methylprednisolone, suggesting a ceiling effect. Limiting the duration of the treatment can reduce hospital stay and costs, without interfering with clinical benefit.