title: Antiviral treatment of Bell's palsy based on baseline severity: a systematic review and meta-analysis.
abstract: OBJECTIVE
  We conducted a systematic review with meta-analysis to evaluate the efficacy of antiviral agents on complete recovery of Bell's palsy.
  
  
  METHODS
  We searched CENTRAL, Embase, MEDLINE, International Pharmaceutical Abstracts, and sources of unpublished literature to November 1, 2014. Primary and secondary outcomes were complete and satisfactory recovery, respectively. To evaluate statistical heterogeneity, we performed subgroup analysis of baseline severity of Bell's palsy and between-study sensitivity analyses based on risk of allocation and detection bias.
  
  
  RESULTS
  The 10 included randomized controlled trials (2419 patients; 807 with severe Bell's palsy at onset) had variable risk of bias, with 9 trials having a high risk of bias in at least 1 domain. Complete recovery was not statistically significantly greater with antiviral use versus no antiviral use in the random-effects meta-analysis of 6 trials (relative risk, 1.06; 95% confidence interval, 0.97-1.16; I(2) = 65%). Conversely, random-effects meta-analysis of 9 trials showed a statistically significant difference in satisfactory recovery (relative risk, 1.10; 95% confidence interval, 1.02-1.18; I(2) = 63%). Response to antiviral agents did not differ visually or statistically between patients with severe symptoms at baseline and those with milder disease (test for interaction, P = .11). Sensitivity analyses did not show a clear effect of bias on outcomes.
  
  
  CONCLUSIONS
  Antiviral agents are not efficacious in increasing the proportion of patients with Bell's palsy who achieved complete recovery, regardless of baseline symptom severity.
authors.affiliation: University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada. Electronic address: ricky.turgeon@alumni.ubc.ca.
authors.forename: Ricky D
authors.initials: RD
authors.lastname: Turgeon
authors.affiliation: Qatar University, College of Pharmacy, Doha, Qatar.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Wilby
authors.affiliation: University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada.
authors.forename: Mary H H
authors.initials: MH
authors.lastname: Ensom
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D020330:Bell Palsy / Q000188:drug therapy*; D006801:Humans
chemical_list: D000998:Antiviral Agents
keywords: Antiviral; Bell's palsy; Facial nerve