1. 2018;21;559-569A Network Meta-Analysis to Compare the Efficacy of Steroid and Antiviral Medications for Facial Paralysis from Bell´s Palsy
   Systematic Review
   Xiying Fu, MD, Linda Tang, MD, Can Wang, MD, Ming Li, MD, Huijie Wu, MD, Jinyao Li, MD, Qianqian Ma, MD, and Wei Yang, MD.

BACKGROUND: Facial paralysis is the most common cranial nerve injury. Bell’s palsy is the name commonly used to describe an acute peripheral facial paralysis of unknown origin. The annual incidence of Bell’s palsy is 20-30 cases per 100,000 persons, regardless of age and gender.

OBJECTIVE: Our objective was to appraise the efficacy of steroid and antiviral treatments for facial paralysis.

STUDY DESIGN: We conducted a network meta-analysis of studies of steroid and antiviral treatments for facial paralysis.

SETTING: Second Hospital of Jilin University.

METHODS: We performed a systematic search of PubMed and Embase databases to retrieve relevant studies. The efficacy outcome was overall recovery, measured in terms of the odds ratio (OR) and a corresponding 95% confidence interval (CI). The comprehensive ranking for each treatment with respect to overall recovery is presented as the value of the surface under the cumulative ranking curve (SUCRA).

RESULTS: A total of 23 articles representing 4,623 patients were eligible for our study. In terms of overall recovery, no significant differences were found in the pairwise meta-analysis. From the results of the network meta-analysis, antiviral combined with steroid treatment was superior to placebo treatment (OR = 3.25; 95% CI, 1.23-8.61), but neither steroid nor antiviral therapy alone resulted in significant benefit compared with placebo. According to the SUCRA, antiviral combined with steroid treatment was the most effective, with a SUCRA value of 0.96, and the probability of ranking first was 90%. Only a small difference was observed between the efficacies of steroid and antiviral treatments (SUCRA values of 0.55 and 0.36, respectively), and they were both better than the placebo (SUCRA value of 0.134).

LIMITATIONS: The major limitation of our study is that, due to the limited number of related studies in the last several years, we were not able to evaluate the safety of these therapies.

CONCLUSIONS: Antiviral combined with steroid therapy is significantly better than antiviral or steroid therapy alone with respect to overall recovery, and the efficacies of single antiviral medications or single steroid treatments are nearly equal. In addition, all 3 therapies are more effective than placebo, according to the SUCRA values.

KEY WORDS: Facial paralysis, Bell´s palsy, steroids, antiviral drugs, efficacy, overall recovery, network meta-analysis, SUCRA