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- Title
Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis.
- Authors
de Almeida JR; Al Khabori M; Guyatt GH; Witterick IJ; Lin VY; Nedzelski JM; Chen JM; de Almeida, John R; Al Khabori, Murtadha; Guyatt, Gordon H; Witterick, Ian J; Lin, Vincent Y W; Nedzelski, Julian M; Chen, Joseph M
- Abstract
<bold>Context: </bold>New evidence has emerged regarding the use of corticosteroids and antiviral agents in Bell palsy.<bold>Objective: </bold>To estimate the association of corticosteroids and antiviral agents with the risk of unsatisfactory facial recovery in patients with Bell palsy.<bold>Data Sources: </bold>The search included MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, Web of Science, PAPERSFIRST, PROCEEDINGSFIRST, and PROQUEST to identify studies up to March 1, 2009.<bold>Study Selection and Data Extraction: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.
- Publication
JAMA: Journal of the American Medical Association, 2009, Vol 302, Issue 9, p985
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2009.1243