Antivirale Therapie der idiopathischen Fazialisparese

Background & Objectives

Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell’s palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. This review was first published in 2001 and most recently updated in 2015. Since a significant benefit of corticosteroids for the early management of Bell’s palsy has been demonstrated, the main focus of this update, as in the previous version, was to determine the effect of adding antivirals to corticosteroid treatment. Objectives: To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell’s palsy.

Selection Criteria & Main results

We considered randomised controlled trials (RCTs) or quasi‐RCTs of antivirals with and without corticosteroids versus control therapies for the treatment of Bell’s palsy.
Fourteen trials, including 2488 participants, met the inclusion criteria. Most were small, and most were at high or unclear risk of bias in multiple domains. We included four new studies at this update.

Incomplete recovery

A combination of antivirals and corticosteroids may have little or no effect on rates of incomplete recovery in people with Bell’s palsy compared to corticosteroids alone (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.38 to 1.74; 3 trials, N = 766; random‐effects; low‐certainty evidence). We excluded 10 trials that were at high or unclear risk of bias in several domains from this analysis and limited all analyses to studies at lower risk of bias. Recovery rates were better in participants receiving corticosteroids alone than antivirals alone (RR 2.69, 95% CI 0.73 to 10.01; 2 trials, N = 667; random‐effects), but the result was imprecise and allowed for the possibility of no effect. The rate of incomplete recovery was lower with antivirals plus corticosteroids than with placebo or no treatment (RR 0.56, 95% CI 0.42 to 0.76; 2 trials, N = 658; random‐effects). Antivirals alone had no clear effect on incomplete recovery rates compared with placebo, but the result was imprecise (RR 1.10, 95% CI 0.87 to 1.40; 2 trials, N = 658; fixed‐effect). For people with severe Bell’s palsy (House‐Brackmann score of 5 and 6, or equivalent on other scales), we found that the combination of antivirals and corticosteroids had no clear effect on incomplete recovery at month six compared to corticosteroids alone, although the result was again imprecise (RR 0.82, 95% CI 0.57 to 1.17; 2 trials, N = 98; random‐effects).

Motor synkinesis or crocodile tears

Antivirals plus corticosteroids reduced the proportion of participants who experienced these long‐term sequelae from Bell’s palsy compared to placebo plus corticosteroids (RR 0.56, 95% CI 0.36 to 0.87; 2 trials, N = 469; fixed‐effect; moderate‐certainty evidence). Antivirals plus corticosteroids reduced long‐term sequelae compared to placebo but there was no clear difference in this outcome with antivirals alone compared to placebo.

Authors‘ conclusions

The combination of antivirals and corticosteroids may have little or no effect on rates of incomplete recovery in comparison to corticosteroids alone in Bell’s palsy of various degrees of severity, or in people with severe Bell’s palsy, but the results were very imprecise. Corticosteroids alone were probably more effective than antivirals alone and antivirals plus corticosteroids were more effective than placebo or no treatment. There was no clear benefit from antivirals alone over placebo.
The combination of antivirals and corticosteroids probably reduced the late sequelae of Bell’s palsy compared with corticosteroids alone. Studies also showed fewer episodes of long‐term sequelae in corticosteroid‐treated participants than antiviral‐treated participants.
We found no clear difference in adverse events from the use of antivirals compared with either placebo or corticosteroids, but the evidence is too uncertain for us to draw conclusions.

Fazit:

Cortison alleine war effektiver als antivirale Medikation. Cortison mit antiviraler Medikation war auch nicht besser als Cortison alleine.
Die Kombination hat aber wohl etwas besser die Folgekrankheiten lindern können.