Professor of Otology/Neurotology, Otorhinolaryngology Research Center, Department of Otolaryngology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Associate Professor of Psychiatry, Kavosh Cognitive Behavior Sciences and Addiction Research Center, Department of Psychiatry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Laryngoscope. 2021 Jul;131(7):1615-1625. doi: 10.1002/lary.29368. Epub 2021 Jan 6.
We aimed to simultaneously compare all available medical treatments for Bell's palsy using both direct and indirect data.
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.
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.
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.
本研究旨在同时使用直接和间接数据比较所有可用的贝尔麻痹医学治疗方法。
检索了 1990 年 1 月 1 日至 2020 年 3 月 1 日的文献，不限制语言。当前的网络荟萃分析纳入了比较药物干预的随机临床试验。我们使用贝叶斯框架中的随机效应网络荟萃分析估计了汇总风险比（RR）、95%可信区间（CrI）和累积排序曲线下面积（SUCRA）。主要结局为随机分组后短期（≤3 个月）和中期/长期（>3 个月）的完全恢复。次要结局为联带运动。
共检索到 21 项试验，包含 2839 名参与者。在良好恢复方面，与安慰剂相比，皮质类固醇加抗病毒药物是最有效的治疗方法，短期 RR 范围为 1.25（95% CrI：1.10，1.43），中期/长期 RR 范围为 1.26（95% CrI：1.11，1.45）。对于联带运动，只有皮质类固醇加抗病毒药物（RR 0.35；95% CrI：0.19，0.65）与安慰剂相比，联带运动的发生率较低。良好恢复和联带运动的证据确定性分别为极低低和中高度。
这项网络荟萃分析表明，联合治疗仍然是良好恢复结果的最佳方案，也是联带运动的唯一有效方案。需要进一步的研究来证实这些发现。《喉镜》，131：1615-1625，2021。
