Combined antiviral agents with corticosteroids versus corticosteroids alone in the treatment of Bell’s palsy: a systematic review

Abstract

OBJECTIVE

To compare the efficacy between using combined antiviral agents with corticosteroids and corticosteroids alone for treatment of Bell’s palsy.

METHODS

We systematically searched through electronic databases including The Cochrane Library, MEDLINE, Scopus, CINAHL, ClinicalTrials.gov as well as other sources than database such as Google scholar and hand searching of published randomized controlled trials (RCTs). We considered of participants were diagnosed with unilateral facial paralysis without any identifiable causes, who started therapy within seven days from the onset of the disease, and who satisfied the author’s requirement for eligibility and inclusion. We assessed participants who received any types of corticosteroids therapy alone versus the combination of corticosteroids with acyclovir, valacyclovir or famciclovir, regardless of routes, dosages and duration of administration of the therapies. The primary outcome was the incomplete recovery of facial function.

RESULTS

We included ten RCTs with a total of 1,850 participants, who received combined antiviral agents with corticosteroids (n=922) and corticosteroids (n=928). Our study showed combined antiviral agents with corticosteroids statistically significant reduced incomplete recovery of facial function than corticosteroids alone for Bell’s palsy treatment (relative risk (RR), 0.74; 95% confidence interval (CI), 0.61 to 0.90; I2=38%). Combined famciclovir with corticosteroids showed a significant benefit more than corticosteroids alone (RR, 0.44; 95% CI, 0.27 to 0.71). It also showed combined antiviral agents with the cumulative dose of prednisolone greater than 400 mg but less than 500 mg significantly reduced in incomplete recovery of facial function (RR, 0.73; 95% CI, 0.55 to 0.98) than both cumulative doses that lesser than or equal 400 mg and at least 500 mg of prednisolone (RR, 0.77; 95% CI, 0.55 to 1.07), (RR, 1.04; 95% CI, 0.48 to 2.26) respectively.

CONCLUSION

In conclusion, there was evidence of a benefit of famciclovir in combination with greater than 400 mg but less than 500 mg of prednisolone for Bell’s palsy treatment.