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Optic Neuritis Treatment Trial (ONTT)

June, 2008

Clinical Trial

A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis.

Arch Neurol. 2008 Jun;65(6):727-32.
Full text

Main finding: The presence of brain MRI abnormalities at the time of an optic neuritis attack is a strong predictor of the 15-year risk of Multiple Sclerosis

 

  • Purpose: To assess the risk of developing multiple sclerosis (MS) after optic neuritis and the factors predictive of high and low risk.
  • Study type: Randomized controlled trial
  • Condition: Optic Neuritis

Participants: Acute optic neuritis

 

  • n=457

 

Intervention:

 

Group 1: Oral steroids (oral prednisone (1mg/kg/day) for 14 days)
Group 2: IV then oral steroids (intravenous methylprednisolone (1 g/day) for 3 days, then oral prednisone (1mg/kg/day) for 11 days)
Group 3: Placebo (oral for 14 days

The cumulative probability of developing MS by 15 years after onset of optic neuritis was 50% and is strongly related to presence of lesions on baseline MRI.

 

25% of patients with no lesions on baseline brain MRI developed MS compared with 72% of patients with 1 or more lesions.

Outcome Overall None 1 2 ≥3
15-year probability of MS (%) 50% 25% 60% 68% 78%

February 27, 1992

Clinical Trial

A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis.

Beck RW, Cleary PA, Anderson MM Jr, Keltner JL, Shults WT, Kaufman DI, Buckley EG, Corbett JJ, Kupersmith MJ, Miller NR, et al.

N Engl J Med. 1992 Feb 27;326(9):581-8.
Full text

Main finding: Intravenous methylprednisolone followed by oral prednisone speeds the recovery of visual loss due to optic neuritis. Oral prednisone alone is ineffective and increases the risk of new episodes of optic neuritis.

 

  • Purpose: To evaluate corticosteroids as treatment for optic neuritis
  • Study type: Randomized controlled trial
  • Condition: Optic Neuritis

Participants: Acute optic neuritis

 

  • n=457

 

Intervention:

 

Group 1: Oral steroids (oral prednisone (1mg/kg/day) for 14 days)
Group 2: IV then oral steroids (intravenous methylprednisolone (1 g/day) for 3 days, then oral prednisone (1mg/kg/day) for 11 days)
Group 3: Placebo (oral for 14 days)

Visual recovery was faster in the iv methylpred + po prednisone group vs placebo. At 6 months visual acuity in the 3 groups were similar, but visual fields, contrast sensitivity and colour vision was slightly better in the iv methylpred group.

 

The rate of new episodes of optic neuritis was higher in the oral prednisone group

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Updated on March 7th, 2022

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