Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis.

Abstract

CONTEXT:

New evidence has emerged regarding the use of corticosteroids and antiviral agents in Bell palsy.

OBJECTIVE:

To estimate the association of corticosteroids and antiviral agents with the risk of unsatisfactory facial recovery in patients with Bell palsy.

DATA SOURCES:

The search included MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, Web of Science, PAPERSFIRST, PROCEEDINGSFIRST, and PROQUEST to identify studies up to March 1, 2009.

STUDY SELECTION AND DATA EXTRACTION:

Eligible studies were randomized controlled trials comparing treatment with either corticosteroids or antiviral agents with a control and measuring at least 1 of the following outcomes: unsatisfactory facial recovery (> or = 4 months), unsatisfactory short-term recovery (6 weeks to < 4 months), synkinesis and autonomic dysfunction, or adverse effects. Two reviewers extracted data on study characteristics, methods, and outcomes. Disagreement was resolved by consensus.

RESULTS:

Eighteen trials involving 2786 patients were eligible. Regression analysis identified a synergistic effect when corticosteroids and antiviral agents were administered in combination compared with alone (odds ratio for interaction term, 0.54 [95% confidence interval {CI}, 0.35-0.83]; P = .004). Meta-analysis using a random-effects model showed corticosteroids alone were associated with a reduced risk of unsatisfactory recovery (relative risk [RR], 0.69 [95% CI, 0.55-0.87]; P = .001) (number needed to treat to benefit 1 person, 11 [95% CI, 8-25]), a reduced risk of synkinesis and autonomic dysfunction (RR, 0.48 [95% CI, 0.36-0.65]; P < .001) (number needed to treat to benefit 1 person, 7 [95% CI, 6-10]), and no increase in adverse effects. Antiviral agents alone were not associated with a reduced risk of unsatisfactory recovery (RR, 1.14 [95% CI, 0.80-1.62]; P = .48). When combined with antiviral agents, corticosteroids were associated with greater benefit (RR, 0.48 [95% CI, 0.29-0.79]; P = .004) than antiviral agents alone. When combined with corticosteroids, antiviral agents were associated with greater risk reduction of borderline significance compared with corticosteroids alone (RR, 0.75 [95% CI, 0.56-1.00]; P = .05).

CONCLUSIONS:

In Bell palsy, corticosteroids are associated with a reduced risk of unsatisfactory recovery. Antiviral agents, when administered with corticosteroids, may be associated with additional benefit.

• Authors: John R de Almeida, Murtadha Al Khabori, Gordon H Guyatt, Ian J Witterick, Vincent Y W Lin, Julian M Nedzelski, Joseph M Chen
• Journal: JAMA (JAMA) Vol. 302 Issue 9 Pg. 985-93 (Sep 02 2009) ISSN: 1538-3598 [Electronic] United States
• PMID: 19724046 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)

Chemical References

• Adrenal Cortex Hormones
• Antiviral Agents

Topics

• Adrenal Cortex Hormones (administration & dosage, therapeutic use)
• Antiviral Agents (administration & dosage, therapeutic use)
• Bell Palsy (drug therapy)
• Drug Therapy, Combination
• Humans
• Randomized Controlled Trials as Topic