Sialakis Christos, Frantzana Aikaterini, Iliadis Christos, Ouzounakis Peter, Kourkouta Lambrini
Otorhinolaryngology Private Practice, Thessaloniki, Greece.
School of Sciences, Department of Health Sciences, School of Medicine, European University Cyprus, Nicosia, Cyprus; George Papanikolaou General Hospital of Thessaloniki, Greece.
Med Pharm Rep. 2025 Jul;98(3):267-282. doi: 10.15386/mpr-2786. Epub 2025 Jul 30.
This study aims to investigate the effectiveness of steroids plus antivirals versus steroids alone in the treatment of Bell's palsy. Due to conflicting results in the existing literature, we conducted this meta-analysis to synthesize the available evidence and extract a more complete conclusion.
We searched electronic databases PubMed, CINAHL, ScienceDirect, MEDLINE, OVID, and Scopus. The last search was performed on March 2024. In this study, 7 randomized controlled trials were included. We used random and fixed effects for sensitivity analysis for each outcome, and we further proceeded to perform a Bayesian meta-analysis using priors and calculate the posterior distribution.
Performing frequentist meta-analysis, both the random and fixed effects showed statistical significance, indicating the superiority of the combination treatment. The random log odds ratio was 0.5865 [95% CI: 0.0141 to 1.1589 and the Back-Transform Log Odds Ratio to Odds Ratio was 1.798 [95% CI: 1.014 to 3.186]. The fixed effect log odds ratio was 0.4377 [95%CI: 0.0819 to 0.7934] and the Back-Transform Log Odds Ratio to Odds Ratio was 1.549 [95% CI:1.085 to 2.211]. Neither the rank correlation nor the regression test in both models indicated any funnel plot asymmetry and publication bias.Performing Bayesian meta-analysis, in the posterior distribution the model-averaged log odds ratio was 0.26 [0.00 to 0.90], showing no statistically significant results, as the log odds ratio contains the zero. The inclusion Bayes Factor (BF) for the effect was 1.225 showing anecdotal supporting evidence for the combination treatment. The inclusion BF for the heterogeneity was 0.979, showing no support for its existence in the analysis and the inclusion BF for the publication bias was 0.622, a lower of 1, indicating evidence of its absence in the analysis.
The combination of steroids plus an antiviral agent, is more efficacious than steroid monotherapy in treating Bell's palsy. This conclusion is supported by frequentist analysis, but not by the Bayesian approach as the Bayesian meta-analysis was inconclusive, suggesting some uncertainty in the effect size but this could be due to priors influence. Further research with advanced syntheses such as network and Bayesian meta-analysis is needed as well as more double-blinded randomized controlled trials.
本研究旨在调查类固醇联合抗病毒药物与单独使用类固醇治疗贝尔氏面瘫的有效性。由于现有文献结果相互矛盾，我们进行了这项荟萃分析，以综合现有证据并得出更完整的结论。
我们检索了电子数据库PubMed、CINAHL、ScienceDirect、MEDLINE、OVID和Scopus。最后一次检索于2024年3月进行。本研究纳入了7项随机对照试验。我们对每个结果使用随机和固定效应进行敏感性分析，并进一步使用先验进行贝叶斯荟萃分析并计算后验分布。
进行频率学派荟萃分析时，随机效应和固定效应均显示出统计学意义，表明联合治疗的优越性。随机对数优势比为0.5865 [95%置信区间：0.0141至1.1589]，对数优势比反向转换为优势比为1.798 [95%置信区间：1.014至3.186]。固定效应对数优势比为0.4377 [95%置信区间：0.0819至0.7934]，对数优势比反向转换为优势比为1.549 [95%置信区间：1.085至2.211]。两个模型中的秩相关和回归检验均未表明存在任何漏斗图不对称和发表偏倚。进行贝叶斯荟萃分析时，在后验分布中，模型平均对数优势比为0.26 [0.00至0.90]，由于对数优势比包含零，因此未显示出统计学意义。效应的纳入贝叶斯因子（BF）为1.225，表明联合治疗有轶事支持证据。异质性的纳入BF为0.979，表明分析中不支持其存在，发表偏倚的纳入BF为0.622，低于1，表明分析中不存在其证据。
类固醇联合抗病毒药物治疗贝尔氏面瘫比类固醇单药治疗更有效。这一结论得到了频率学派分析的支持，但贝叶斯方法未支持，因为贝叶斯荟萃分析尚无定论，这表明效应大小存在一些不确定性，但这可能是由于先验影响。需要进行进一步的研究，采用网络和贝叶斯荟萃分析等先进的综合方法，以及更多的双盲随机对照试验。
