Table 1

Investigations into the early treatment for AON

InterventionParticipantsOutcomeSide effectsReference
ACTH 40 IU/day×30 days (n=25)
Placebo (n=25)
50 patients with acute retrobulbar neuritisPatients treated with ACTH recovered ‘more quickly and more completely’ (high-contrast visual acuity)Facial or ankle oedema69
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 visionWeight gain, facial oedema, ankle oedema, acne, depression, rash70
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 neuritisEPO-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 significanceIVMP—hot flashes, facial flushing, mood changes and hyperglycaemia attributed to IVMP
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 centresThe 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 acuityIVMP—transient depression, acute pancreatitis
IVMP, prednisone—sleep disturbance, mild mood change, stomach upset and facial flushing
IVMP 1000 mg /day×3 days (n=33)
Placebo (n=33)
66 patients with first episode acute unilateral optic neuritisOptic nerve atrophy at 6 months was similar for placebo and IVMP-treated groups
IVMP did not improve visual outcomes or lesion length
Not reported6 71
Plasma exchange×5 cycles (n=23)10 patients with RRMS, 1 patient with NMO, 12 patients with optic neuritis as a clinically isolated syndrome70% of patients responded to plasma exchange on measures of visual acuity; no control group was included in the studyHypofibrinogenaemia72
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 MSA greater proportion of the IVIg-treated patients demonstrated improvement in their visual acuity compared with untreated control participantGeneralised headaches, infusion reactions73
Case report of 23 patients treated with 5 cycles of plasma exchange23 patients with steroid-unresponsive optic neuritis associated with other conditions (NMO, MS, CIS) in some cases70% of patients showed some improvement74
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 daysGreater RNFL thickness (overall, nasal, inferior, and superior quadrants) in memantine-treated group; no difference in visual functionNone reported61
  • 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.