A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group.
A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group.
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发表时间：
1992
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通讯作者：
R. Beck;P. Cleary;M. M. Anderson-M.;J. Keltner;W. T. Shults;D. Kaufman;E. Buckley;J. Corbett;M. Kupersmith;N. Miller
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作者：
R. Beck;P. Cleary;M. M. Anderson-M.;J. Keltner;W. T. Shults;D. Kaufman;E. Buckley;J. Corbett;M. Kupersmith;N. Miller
背景与方法使用皮质类固醇治疗视神经炎是有争议的。在15个临床中心，我们随机分配457名急性视神经炎患者接受口服强的松治疗（每天每公斤体重1毫克），持续14天；静脉注射甲基强的松龙（每天1克），连续3天，然后口服强的松（每天每公斤1毫克），连续11天；或口服安慰剂14天。视觉功能在六个月的随访期间进行评估。结果静脉注射甲基强的松龙组视力恢复快于安慰剂组；这对于视野缺陷的逆转尤其正确（P = 0.0001）。虽然各组之间的差异随着时间的推移而减小，但在6个月时，静脉注射甲泼尼龙组的视野（P = 0.054）、对比敏感度（P = 0.026）和色觉（P = 0.033）仍稍好，但视力没有改善（P = 0.66）。口服强的松组的结果与安慰剂组没有差异。此外，与安慰剂组相比，口服强的松组双眼视神经炎新发率更高，而静脉注射甲基强的松组则没有（口服强的松与安慰剂的相对危险度为1.79；95%可信区间为1.08 - 2.95）。结论静脉注射甲基强的松后口服强的松可加速视神经炎所致视力丧失的恢复，6个月时视力略有改善。在这项研究中，单独口服强的松是一种无效的治疗方法，并增加视神经炎新发作的风险。
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 methylprednisolone (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.