Investigations into the early treatment for AON
| Intervention | Participants | Outcome | Side effects | Reference |
|---|---|---|---|---|
| ACTH 40 IU/day×30 days (n=25) Placebo (n=25) | 50 patients with acute retrobulbar neuritis | Patients treated with ACTH recovered ‘more quickly and more completely’ (high-contrast visual acuity) | Facial or ankle oedema | 69 |
| ACTH 40 IU/day×30 days (n=27) Placebo (n=27) | 54 patients with acute optic neuritis (4 patients with MS in ACTH group and 5 in placebo group) | No differences in high-contrast visual acuity, visual field, macular threshold or colour vision | Weight gain, facial oedema, ankle oedema, acne, depression, rash | 70 |
| EPO 33 000 IU/day×3 days+IVMP 1000 mg/day×3 days (n=21) Placebo+IVMP 1000 mg/day×3 days (n=19) | 40 patients with first episode optic neuritis | EPO-treated patients had less RNFL thinning, smaller reduction in retrobulbar diameter of optic nerve and shorter VEP latencies; differences in visual function did not reach significance | IVMP—hot flashes, facial flushing, mood changes and hyperglycaemia attributed to IVMP EPO—headache | 14 |
| IVMP 1000 mg/day×3 days+oral prednisone 1 mg/kg×11 days (n=151) Oral prednisone 1 mg/kg×14 days (n=156) Placebo (n=150) | 457 patients with acute optic neuritis across 15 clinical centres | The group receiving IVMP recovered visual function faster than the group receiving oral prednisone only; at 6 months the IVMP group had better contrast sensitivity, colour vision, a trend towards better visual field, but not better visual acuity | IVMP—transient depression, acute pancreatitis IVMP, prednisone—sleep disturbance, mild mood change, stomach upset and facial flushing | 4 |
| IVMP 1000 mg /day×3 days (n=33) Placebo (n=33) | 66 patients with first episode acute unilateral optic neuritis | Optic nerve atrophy at 6 months was similar for placebo and IVMP-treated groups IVMP did not improve visual outcomes or lesion length | Not reported | 6 71 |
| Plasma exchange×5 cycles (n=23) | 10 patients with RRMS, 1 patient with NMO, 12 patients with optic neuritis as a clinically isolated syndrome | 70% of patients responded to plasma exchange on measures of visual acuity; no control group was included in the study | Hypofibrinogenaemia | 72 |
| IVIg 400 mg/kg/day×5 days+IVIg 400 mg/kg/day once monthly for 5 months (n=23) No treatment (n=24) | 47 patients with steroid-refractory optic neuritis in MS | A greater proportion of the IVIg-treated patients demonstrated improvement in their visual acuity compared with untreated control participant | Generalised headaches, infusion reactions | 73 |
| Case report of 23 patients treated with 5 cycles of plasma exchange | 23 patients with steroid-unresponsive optic neuritis associated with other conditions (NMO, MS, CIS) in some cases | 70% of patients showed some improvement | 74 | |
| IVMP 250 mg every 6 h×3 days+oral prednisone 1 mg/kg×11 days+memantine (n=29) IVMP 250 mg every 6 h×3 days+oral prednisone 1 mg/kg×11 days+placebo (n=31) | 60 patients with first attack of AON; visual symptoms <8 days | Greater RNFL thickness (overall, nasal, inferior, and superior quadrants) in memantine-treated group; no difference in visual function | None reported | 61 |
ACTH, adrenocorticotropic hormone; AON, acute optic neuritis; EPO, erythropoietin; IVIg, intravenous immunoglobulin; IVMP, intravenous methylprednisolone; MS, multiple sclerosis; NMO, neuromyelitis optica; RNFL, retinal nerve fibre layer; RRMS, relapsing remitting MS.