Published 7 September 2009, doi:10.1136/bmj.b3354
Cite this as: BMJ 2009;339:b3354

Research

The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis

¹ Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, ² Harvard Medical School, Boston, MA 02115, ³ Division of Neurology, Children’s Hospital Boston, Boston, MA 02115, ⁴ Department of Ophthalmology and Vision Sciences, University of Toronto, St Michael’s Hospital, Toronto, Ontario M5B 1W8, Canada, ⁵ Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA 02115, ⁶ Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA 02215, ⁷ Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114

Objective To determine whether steroids plus antivirals provide a better degree of facial muscle recovery in patients with Bell’s palsy than steroids alone.

Design Meta-analysis.

Data sources PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for studies published in all languages from 1984 to January 2009. Additional studies were identified from cited references.

Selection criteria Randomised controlled trials that compared steroids with the combination of steroids and antivirals for the treatment of Bell’s palsy were included in this study. At least one month of follow-up and a primary end point of at least partial facial muscle recovery, as defined by a House-Brackmann grade of at least 2 (complete palsy is designated a grade of 6) or an equivalent score on an alternative recognised scoring system, were required.

Review methods Two authors independently reviewed studies for methodological quality, treatment regimens, duration of symptoms before treatment, length of follow-up, and outcomes. Odds ratios with 95% confidence intervals were calculated and pooled using a random effects model.

Results Six trials were included, a total of 1145 patients; 574 patients received steroids alone and 571 patients received steroids and antivirals. The pooled odds ratio for facial muscle recovery showed no benefit of steroids plus antivirals compared with steroids alone (odds ratio 1.50, 95% confidence interval 0.83 to 2.69; P=0.18). A one study removed analysis showed that the highest quality studies had the greatest effect on the lack of difference between study arms shown by the odds ratio. Subgroup analyses assessing causes of heterogeneity defined a priori (time from symptom onset to treatment, length of follow-up, and type of antiviral studied) showed no benefit of antivirals in addition to that provided by steroids.

Conclusions Antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy. This study does not, therefore, support the routine use of antivirals in Bell’s palsy. Future studies should use improved herpes virus diagnostics and newer antivirals to assess whether combination therapy benefits patients with more severe facial paralysis at study entry.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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