A double-blind, placebo-controlled trial of adding erythropoietin to intravenous methylprednisolone for the treatment of unilateral acute optic neuritis of unknown or demyelinative origin.

Purpose: To compare the effect of adding recombinant human erythropoietin (rhEPO) to intravenous methylprednisolone for the treatment of unilateral acute optic neuritis of unknown or demyelinative origin on the logarithm of the minimum angle of resolution (logMAR), perimetric variables [mean deviation (MD) and pattern standard deviation (PSD)], and retinal nerve fiber layer (RNFL) thickness in optical coherence tomography (OCT).

Methods: Thirty patients (15 patients in each group) diagnosed with unilateral acute optic neuritis of unknown or demyelinative origin were included. All patients received 1, 000 mg intravenous methylprednisolone per day for 3 days. One intravenous bullous dose of rhEPO with the dose of 33,000 IU was administered at days 1-3 for the patients in group 2. One intravenous bullous dose of 0.9 % normal saline was administered at days 1-3 for group 1 patients. At 6 months post-intervention, in the involved eye, logMAR, MD, PSD, and mean RNFL thickness in each of four quadrants and post-intervention changes in each of the variables were compared between group 1 and group 2.

Results: The amount of MD improvement after the intervention (difference of pre- and post-intervention MDs) was significantly higher in the group 2 patients (p = 0.04). The other post-intervention variables, including post-intervention PSD, amount of PSD improvement, and total and four-quadrant post-intervention RNFL thickness and RNFL loss (difference of pre- and post-intervention RNFL thicknesses), demonstrated no significant differences between group 1 and group 2.

Conclusion: Until more controlled studies are available, the rhEPO is not recommended as an add-on treatment for optic neuritis.