According to the research, bioequivalent doses of oral corticosteroids are a cheaper and effective alternative to intravenous corticosteroids for acute optic neuritis (ON)

“It was important to do the study because high-dose intravenous (IV) corticosteroids have been used to treat acute inflammatory optic neuritis without any evidence of being superior to bioequivalent doses of oral corticosteroids," said Dr. Sarah A. Morrow.

"Clinicians can feel confident prescribing high-dose (1,250 mg oral prednisone) oral corticosteroids in this population,” Dr. Morrow added. “The use of oral corticosteroids is more cost-efficient and more convenient for patients, especially those who do not live close to an infusion center."

"These results will have a marked and immediate effect on patient care. I anticipate that most physicians treating patients with optic neuritis and multiple sclerosis will begin substituting high-dose oral prednisone in situations where they would have previously prescribed intravenous steroids," Dr. Bradley J. Katz said.

“This study will result in fewer patients having to undergo treatment by vein and significantly lower costs to patients, insurance companies, and government health providers."

Dr. Morrow and her colleagues conducted a single-blind (participants unblinded) randomized clinical trial with six-month follow-up at one tertiary care center. They enrolled 55 participants from 2012 to 2015.

Patients were 18 to 64 years of age and presented within 14 days of acute optic neuritis onset, without any recovery at baseline and without the history of optic neuritis in the same eye. All participants had best-corrected visual acuity (BCVA) of 20/40 or worse and required corticosteroid treatment.

The authors treated 23 participants with 1,000 mg IV methylprednisolone sodium succinate and 22 with 1,250 mg oral prednisone. At one month and six months after treatment, the authors recorded recovery of the latency of the P100 component of the visual evoked potential (VEP).

They also assessed BCVA using Early Treatment Diabetic Retinopathy Study letter scores on the alphabet chart and scores on low-contrast letters. At one month, no significant group difference was found in the mean P100 latency recovery.

At six months, P100 latency in the IV group had improved by 62.9 ms (from a mean of 181.9 to 119.0 ms); in the oral group, it had improved by 66.7 ms (from a mean of 200.5 to 133.8 ms), with no significant difference between groups (P=0.07). At one month and six months, BCVA recovery between the groups was similar, as was low-contrast BCVA improvement at six months.

Dr. Cristiano Oliveira, a neuro-ophthalmologist told by email, "The results do not surprise me, but I was surprised by the level of compliance with the treatment and the relatively few reports of gastrointestinal adverse effects in those given oral treatment."

Dr. Katz said, "Most clinicians treating patients with multiple sclerosis and optic neuritis have suspected that oral steroids, at the proper dose, are probably as effective as intravenous steroids. But because there was no evidence to support our suspicion, most of us have played it safe and continued to treat with intravenous steroids.” "So while the findings are not surprising, they are way overdue!" he added.