Pharmacological Treatments of Bell's Palsy in Adults: A Systematic Review and Network Meta-Analysis.

OBJECTIVE

We aimed to simultaneously compare all available medical treatments for Bell's palsy using both direct and indirect data.

METHODS

The literature was searched from January 1, 1990, until March 1, 2020, with no language restrictions. Randomized clinical trials comparing pharmacological interventions were included in the current network meta-analysis. We estimated summary risk ratios (RRs), 95% credible interval (CrI), and the surface under the cumulative ranking curve (SUCRA) using network meta-analyses with random effects in a Bayesian framework. The primary outcomes were complete recovery in short-term (≤3 months) and intermediate/long-term (>3 months) after randomization. The secondary outcome was synkinesis.

RESULTS

In total, 21 trials comprising 2,839 participants were retrieved. In terms of good recovery, corticosteroids plus antivirals were the most effective treatment compared to placebo, with RRs ranging between 1.25 (95% CrI: 1.10, 1.43) for the short-term and 1.26 (95% CrI: 1.11, 1.45) for the intermediate/long-term recovery. For synkinesis, only corticosteroids plus antivirals (RR 0.35; 95% CrI: 0.19, 0.65) were associated with fewer synkinesis rates than placebo. The certainty of the evidence for good recovery and synkinesis was very low-low and moderate-high, respectively.

CONCLUSIONS

This network meta-analysis showed that combined therapy remains the best regimen for a good recovery outcome and the only efficacious regimen for synkinesis. More research is needed to confirm these findings. Laryngoscope, 131:1615-1625, 2021.