Richard J. Davenport, DM, FRCP
In patients with Bell palsy, are steroids plus antiviral drugs more effective than steroids alone for facial muscle recovery?
Included studies compared steroids plus antiviral drugs with steroids alone in patients with Bell palsy. Outcome was facial muscle recovery (assessed using a recognized scoring system). Studies of children or pregnant women were excluded.
PubMed, EMBASE/Excerpta Medica, Web of Science, and Cochrane Central Register of Controlled Trials were searched from 1984 to January 2009 for randomized controlled trials (RCTs) that had ≥ 1 month of follow-up; reference lists of systematic reviews were also searched. 6 trials (n = 1145) met the inclusion criteria; mean Jadad score was 3.5 out of 5. Type of steroid was oral prednisolone in 5 RCTs and oral prednisone in 1 RCT; type of antiviral drug was acyclovir in 3 RCTs, valacyclovir in 2 RCTs, and famciclovir in 1 RCT.
Steroids plus antiviral drugs did not differ from steroids alone for at least partial facial muscle recovery (Table). Subgroup analyses by time between symptom onset and treatment (within 3 vs after 3 d), length of follow-up (≤ 3 vs > 3 mo), and type of antiviral drug also showed no difference between groups.
In patients with Bell palsy, treatment with steroids plus antiviral drugs did not differ from steroids alone for facial muscle recovery.
Steroids plus antiviral drugs vs steroids alone in patients with Bell palsy*
*Abbreviations defined in Glossary. RBI, NNT, and CI calculated from data in article using a random-effects model.
†House-Brackmann grade of at least 2 or equivalent score on an alternate scoring system; complete recovery = House-Brackmann grade 1.
Davenport RJ. Review: Adding antiviral drugs to steroids did not improve facial muscle recovery in Bell palsy. Ann Intern Med. ;152:JC2–10. doi: 10.7326/0003-4819-152-4-201002160-02010
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Published: Ann Intern Med. 2010;152(4):JC2-10.
Infectious Disease, Neurology.
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