Original article| Volume 75, 104737, July 2023

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


      • 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.
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        • Petzold A.
        • Wattjes M.P.
        • Costello F.
        • et al.
        The investigation of acute optic neuritis: a review and proposed protocol.
        Nat. Rev. Neurol. 2014; 10 (447–58)
        • Beck R.W.
        • Cleary P.A.
        • Anderson M.M.
        • Randomized A.
        • et al.
        Controlled trial of corticosteroids in the treatment of acute optic neuritis.
        N. Engl. J. Med. 1992; 326: 581-588
        • Saitakis G.
        • Chwalisz B.K.
        Treatment and relapse prevention of typical and atypical optic neuritis.
        Int. J. Mol. Sci. 2022; 23
        • Von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        Ann. Intern. Med. 2007; 147: 573-577
        • Ducloyer J.B.
        • Marignier R.
        • Wiertlewski S.
        • et al.
        Optic neuritis classification in 2021.
        Eur. J. Ophthalmol. 2021;
        • Buttgereit F.
        • da Silva J.A.P.
        • Boers M.
        • et al.
        Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology.
        Ann. Rheum. Dis. 2002; 61: 718-722
        • Le Page E.
        • Veillard D.
        • Laplaud D.A.
        • et al.
        COPOUSEP investigators; west network for excellence in neuroscience. oral versus intravenous high-dose methylprednisolone for treatment of relapses in patients with multiple sclerosis (COPOUSEP): a randomised, controlled, double-blind, non-inferiority trial.
        Lancet. 2015; 386 (Sep 5Epub 2015 Jun 28. Erratum in: Lancet. 2016 Jan 23;387(10016):340. PMID: 26135706): 974-981
        • Campana I.G.
        • Silva G.D.
        • Apóstolos-Pereira S.L.
        • Callegaro D.
        Successful treatment with 5-day oral 1 g/day methylprednisolone of optic neuritis and myelitis in AQP4 positive neuromyelitis optica: a report of two cases.
        Neuroimmunol. Rep. 2021; 1 (VolumeISSN 2667-257X)100045