Highlights
- •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.
Abstract
Background
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.
Methods
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.
Results
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.
Conclusion
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.
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Article info
Publication history
Published online: April 26, 2023
Accepted:
April 25,
2023
Received in revised form:
April 8,
2023
Received:
January 27,
2023
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
