Dados do Trabalho

Título

Comparison of visual acuity recovery in 3-,5-, and 7-day schedules of intravenous methylprednisolone in patients with optic neuritis: a case-control study

Resumo

 Introduction: Intravenous methylprednisolone (IVMP) is the main therapy for optic neuritis to accelerate and improve final visual outcomes. However, systematic reviews demonstrated studies used different schedules of IVMP 1 g/day and the optimal duration of IVMP is unknown.
Objective: We aimed to investigate if 3-day, 5-day, and 7-day schedules of IVMP could lead to different recovery of visual outcomes.
Methods: We performed a case-control study in a tertiary center in São Paulo, Brazil. We selected from a registry of consecutive patients with optic neuritis, patients that received 7-day and 3-day schedules of IVMP 1 g/day. We chose controls with 5-day schedules of IVMP, matching the groups with a propensity score for significant prognostic variables in optic neuritis – age, baseline severity of disease, the presence of anti-AQP4 antibody, the time from symptom onset to IVMP, and the co-intervention with plasma exchange. Our primary outcome was the percentage of patients with incomplete recovery of the visual acuity at 6-12 months, using the Rosembaum Chart. As sensitivity analyses, we tested if the results were consistent using an estimated LogMar scale and evaluating two different timepoints: the discharge and one month after symptom onset.
Results: We screened 107 patients for eligibility. We found 24 patients that received 7-day schedule of IVMP and 11 patients that received 3-day schedule of IVMP. After exclusion of patients due to missing of significant data in confounding variables, we matched 22 patients with 7-day with 22 patients with 5-day IVMP and 11 patients with 3-day with 11 patients with 5-day IVMP schedules. We found that the percentage of patients with incomplete visual acuity recovery, adjusted by prognostic variables, was similar at 6-12 months when we compared 3-day versus 5-day and 7-day versus 5-day schedules. Our results remained in different scale (LogMAR) and timepoints (at discharge and one month after symptom onset).
Conclusion: Shorter IVMP 1 g/day schedules appears to be as effective as longer schedules in the recovery of visual acuity in patients with optic neuritis. We should consider 3-day instead of 5-day schedules for mild cases and 5-day instead of 7-day schedules for severe cases.