Abstract
Objectives
Antiviral treatments for Bell palsy have been widely used, but there is no definite conclusion of which is the most effective antiviral drug. We conducted a systematic review of randomized controlled trials (RCTs) including network meta-analysis to investigate the comparative effectiveness of antiviral treatments for Bell palsy.
Data
RCTs comparing effectiveness between antiviral treatments and placebo were included. Risk of bias within and across studies was assessed with the Cochrane tool and the GRADE approach, respectively. Random-effects pairwise meta-analyses were conducted, followed by network meta-analysis.
Sources
Three electronic databases were searched from inception to May 18, 2020.
Study selection
11 trials and 3393 patients with four arms and eleven contrasts were included.
Results
Significant differences were observed between placebo and famciclovir with respect to overall recovery and no statistically significant differences were found from other comparisons. Treatment ranking based on the evidence network indicated that famciclovir shared the best results, followed by valacyclovir, acyclovir, and finally placebo. Adverse events of famciclovir were too rare and slight to be analyzed. Our confidence in pairwise comparisons was moderate to low, due to study limitations, inconsistency, and imprecision; our confidence in ranking was moderate, due to study limitations. Inconsistency is not deemed to exist by a loop-specific approach and node-splitting procedure. Results of exploring publication bias are satisfying.
Conclusions
According to pairwise and network comparisons, famciclovir could be better than placebo and the effectiveness of other antiviral treatments are similar. For clinical efficacy, famciclovir obtains the best recovery rate of facial function for Bell palsy. Acyclovir has the lowest rate of synkinesis, though, it is not adequately recommended and more superior trails are needed in the future.
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Change history
01 February 2022
A Correction to this paper has been published: https://doi.org/10.1007/s00415-022-10976-5
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The article was supported by “345 Talent Project of Shengjing Hospital”.
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Jiajie Cao contributed to the majority of the writing and performed the statistics; Xinyue Zhang provided data; Zhiming Wang edited the article.
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The original online version of this article was revised: The Funding information section was missing.
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Cao, J., Zhang, X. & Wang, Z. Effectiveness comparisons of antiviral treatments for Bell palsy: a systematic review and network meta-analysis. J Neurol 269, 1353–1367 (2022). https://doi.org/10.1007/s00415-021-10487-9
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DOI: https://doi.org/10.1007/s00415-021-10487-9