The Experts below are selected from a list of 100710 Experts worldwide ranked by ideXlab platform
Frank Sullivan - One of the best experts on this subject based on the ideXlab platform.
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antiviral agents added to Corticosteroids for early treatment of adults with acute idiopathic facial nerve paralysis bell palsy
JAMA, 2016Co-Authors: Frank Sullivan, Fergus Daly, Ildiko GagyorAbstract:Clinical Question Compared with oral Corticosteroids alone, are oral antiviral drugs associated with improved outcomes when combined with oral Corticosteroids in patients presenting within 72 hours of the onset of Bell palsy? Bottom Line Compared with oral Corticosteroids alone, the addition of acyclovir, valacyclovir, or famcyclovir to oral Corticosteroids for treatment of Bell palsy was associated with a higher proportion of people who recovered at 3- to 12-month follow-up. The quality of evidence is limited by heterogeneity, imprecision of the result estimates, and risk of bias.
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antiviral treatment for bell s palsy idiopathic facial paralysis
Cochrane Database of Systematic Reviews, 2015Co-Authors: Ildiko Gagyor, Fergus Daly, Vishnu Madhok, Dhruvashree Somasundara, Michael Sullivan, Fiona Gammie, Frank SullivanAbstract:BACKGROUND: 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. Significant morbidity can be associated with severe cases of Bell's palsy.OBJECTIVES: To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy.METHODS:Search methods:On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies.Selection criteria:We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without Corticosteroids versus control therapies for the treatment of Bell's palsy.We excluded trials that had a high risk of bias in several domains.Data collection and analysis:Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures.MAIN RESULTS: Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recovery:We found no significant benefit from adding antivirals to Corticosteroids in comparison with Corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.47 to 1.02, n = 1715). For people with severe Bell's palsy (House Brackmann scores of 5 and 6 or the equivalent in other scales), we found aMotor synkinesis or crocodile tears:In three trials comparing antivirals and Corticosteroids with Corticosteroids and placebo that assessed this outcome, we found a significant difference in long-term sequelae in favour or antivirals plus Corticosteroids (RR 0.73, 95% CI 0.54 to 0.99, n = 869). Three trials comparing antivirals alone with Corticosteroids alone investigating this outcome showed fewer sequelae with Corticosteroids (RR 1.44, 95% CI 1.11 to 1.85, n = 873). We found no data on long-term sequelae for other comparisons.Adverse events:Adverse event data were available in three studies giving comparison data on 1528 participants. None of the four comparisons (antivirals plus Corticosteroids versus Corticosteroids plus placebo or no treatment; antivirals versus Corticosteroids; antivirals plus Corticosteroids versus placebo; antivirals versus placebo) showed significant differences in adverse events between treatment and control arms. We could find no correlation with specific treatment within these results.AUTHORS' CONCLUSIONS: Moderate-quality evidence from randomised controlled trials showed no additional benefit from the combination of antivirals with Corticosteroids compared to Corticosteroids alone or with placebo, and no benefit from antivirals alone compared to placebo, for the treatment of Bell's palsy. Moderate-quality evidence showed a small but just significant benefit of combination therapy compared with Corticosteroids alone in severe Bell's palsy. We found no significant increase in adverse events from the use of antivirals compared with either placebo or Corticosteroids.
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withdrawn antiviral treatment for bell s palsy idiopathic facial paralysis
Cochrane Database of Systematic Reviews, 2015Co-Authors: Ildiko Gagyor, Fergus Daly, Vishnu Madhok, Dhruvashree Somasundara, Michael Sullivan, Fiona Gammie, Frank SullivanAbstract:Background 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. Significant morbidity can be associated with severe cases of Bell's palsy. Objectives To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy. Search methods On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies. Selection criteria We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without Corticosteroids versus control therapies for the treatment of Bell's palsy. We excluded trials that had a high risk of bias in several domains. Data collection and analysis Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures. Main results Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recoveryWe found no significant benefit from adding antivirals to Corticosteroids in comparison with Corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.47 to 1.02, n = 1715). For people with severe Bell's palsy (House-Brackmann scores of 5 and 6 or the equivalent in other scales), we found a reduction in the rate of incomplete recovery at month six when antivirals plus Corticosteroids were used (RR 0.64, 95% CI 0.41 to 0.99, n = 478). The outcome for the participants receiving Corticosteroids alone was significantly better than for those receiving antivirals alone (RR 2.09, 95% CI 1.36 to 3.20, n = 1169). The treatment effect of placebo was significantly lower than that of antivirals plus Corticosteroids (RR 0.56, 95% CI 0.41 to 0.76, n = 658). Antivirals alone had a non-significant detrimental effect on the outcome compared with placebo (RR 1.10, 95% CI 0.87 to 1.40, n = 658). Motor synkinesis or crocodile tearsIn three trials comparing antivirals and Corticosteroids with Corticosteroids and placebo that assessed this outcome, we found a significant difference in long-term sequelae in favour or antivirals plus Corticosteroids (RR 0.73, 95% CI 0.54 to 0.99, n = 869). Three trials comparing antivirals alone with Corticosteroids alone investigating this outcome showed fewer sequelae with Corticosteroids (RR 1.44, 95% CI 1.11 to 1.85, n = 873). We found no data on long-term sequelae for other comparisons. Adverse events Adverse event data were available in three studies giving comparison data on 1528 participants. None of the four comparisons (antivirals plus Corticosteroids versus Corticosteroids plus placebo or no treatment; antivirals versus Corticosteroids; antivirals plus Corticosteroids versus placebo; antivirals versus placebo) showed significant differences in adverse events between treatment and control arms. We could find no correlation with specific treatment within these results. Authors' conclusions Moderate-quality evidence from randomised controlled trials showed no additional benefit from the combination of antivirals with Corticosteroids compared to Corticosteroids alone or with placebo, and no benefit from antivirals alone compared to placebo, for the treatment of Bell's palsy. Moderate-quality evidence showed a small but just significant benefit of combination therapy compared with Corticosteroids alone in severe Bell's palsy. We found no significant increase in adverse events from the use of antivirals compared with either placebo or Corticosteroids.
Ildiko Gagyor - One of the best experts on this subject based on the ideXlab platform.
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antiviral agents added to Corticosteroids for early treatment of adults with acute idiopathic facial nerve paralysis bell palsy
JAMA, 2016Co-Authors: Frank Sullivan, Fergus Daly, Ildiko GagyorAbstract:Clinical Question Compared with oral Corticosteroids alone, are oral antiviral drugs associated with improved outcomes when combined with oral Corticosteroids in patients presenting within 72 hours of the onset of Bell palsy? Bottom Line Compared with oral Corticosteroids alone, the addition of acyclovir, valacyclovir, or famcyclovir to oral Corticosteroids for treatment of Bell palsy was associated with a higher proportion of people who recovered at 3- to 12-month follow-up. The quality of evidence is limited by heterogeneity, imprecision of the result estimates, and risk of bias.
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antiviral treatment for bell s palsy idiopathic facial paralysis
Cochrane Database of Systematic Reviews, 2015Co-Authors: Ildiko Gagyor, Fergus Daly, Vishnu Madhok, Dhruvashree Somasundara, Michael Sullivan, Fiona Gammie, Frank SullivanAbstract:BACKGROUND: 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. Significant morbidity can be associated with severe cases of Bell's palsy.OBJECTIVES: To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy.METHODS:Search methods:On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies.Selection criteria:We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without Corticosteroids versus control therapies for the treatment of Bell's palsy.We excluded trials that had a high risk of bias in several domains.Data collection and analysis:Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures.MAIN RESULTS: Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recovery:We found no significant benefit from adding antivirals to Corticosteroids in comparison with Corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.47 to 1.02, n = 1715). For people with severe Bell's palsy (House Brackmann scores of 5 and 6 or the equivalent in other scales), we found aMotor synkinesis or crocodile tears:In three trials comparing antivirals and Corticosteroids with Corticosteroids and placebo that assessed this outcome, we found a significant difference in long-term sequelae in favour or antivirals plus Corticosteroids (RR 0.73, 95% CI 0.54 to 0.99, n = 869). Three trials comparing antivirals alone with Corticosteroids alone investigating this outcome showed fewer sequelae with Corticosteroids (RR 1.44, 95% CI 1.11 to 1.85, n = 873). We found no data on long-term sequelae for other comparisons.Adverse events:Adverse event data were available in three studies giving comparison data on 1528 participants. None of the four comparisons (antivirals plus Corticosteroids versus Corticosteroids plus placebo or no treatment; antivirals versus Corticosteroids; antivirals plus Corticosteroids versus placebo; antivirals versus placebo) showed significant differences in adverse events between treatment and control arms. We could find no correlation with specific treatment within these results.AUTHORS' CONCLUSIONS: Moderate-quality evidence from randomised controlled trials showed no additional benefit from the combination of antivirals with Corticosteroids compared to Corticosteroids alone or with placebo, and no benefit from antivirals alone compared to placebo, for the treatment of Bell's palsy. Moderate-quality evidence showed a small but just significant benefit of combination therapy compared with Corticosteroids alone in severe Bell's palsy. We found no significant increase in adverse events from the use of antivirals compared with either placebo or Corticosteroids.
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withdrawn antiviral treatment for bell s palsy idiopathic facial paralysis
Cochrane Database of Systematic Reviews, 2015Co-Authors: Ildiko Gagyor, Fergus Daly, Vishnu Madhok, Dhruvashree Somasundara, Michael Sullivan, Fiona Gammie, Frank SullivanAbstract:Background 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. Significant morbidity can be associated with severe cases of Bell's palsy. Objectives To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy. Search methods On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies. Selection criteria We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without Corticosteroids versus control therapies for the treatment of Bell's palsy. We excluded trials that had a high risk of bias in several domains. Data collection and analysis Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures. Main results Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recoveryWe found no significant benefit from adding antivirals to Corticosteroids in comparison with Corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.47 to 1.02, n = 1715). For people with severe Bell's palsy (House-Brackmann scores of 5 and 6 or the equivalent in other scales), we found a reduction in the rate of incomplete recovery at month six when antivirals plus Corticosteroids were used (RR 0.64, 95% CI 0.41 to 0.99, n = 478). The outcome for the participants receiving Corticosteroids alone was significantly better than for those receiving antivirals alone (RR 2.09, 95% CI 1.36 to 3.20, n = 1169). The treatment effect of placebo was significantly lower than that of antivirals plus Corticosteroids (RR 0.56, 95% CI 0.41 to 0.76, n = 658). Antivirals alone had a non-significant detrimental effect on the outcome compared with placebo (RR 1.10, 95% CI 0.87 to 1.40, n = 658). Motor synkinesis or crocodile tearsIn three trials comparing antivirals and Corticosteroids with Corticosteroids and placebo that assessed this outcome, we found a significant difference in long-term sequelae in favour or antivirals plus Corticosteroids (RR 0.73, 95% CI 0.54 to 0.99, n = 869). Three trials comparing antivirals alone with Corticosteroids alone investigating this outcome showed fewer sequelae with Corticosteroids (RR 1.44, 95% CI 1.11 to 1.85, n = 873). We found no data on long-term sequelae for other comparisons. Adverse events Adverse event data were available in three studies giving comparison data on 1528 participants. None of the four comparisons (antivirals plus Corticosteroids versus Corticosteroids plus placebo or no treatment; antivirals versus Corticosteroids; antivirals plus Corticosteroids versus placebo; antivirals versus placebo) showed significant differences in adverse events between treatment and control arms. We could find no correlation with specific treatment within these results. Authors' conclusions Moderate-quality evidence from randomised controlled trials showed no additional benefit from the combination of antivirals with Corticosteroids compared to Corticosteroids alone or with placebo, and no benefit from antivirals alone compared to placebo, for the treatment of Bell's palsy. Moderate-quality evidence showed a small but just significant benefit of combination therapy compared with Corticosteroids alone in severe Bell's palsy. We found no significant increase in adverse events from the use of antivirals compared with either placebo or Corticosteroids.
Dale T Umetsu - One of the best experts on this subject based on the ideXlab platform.
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Corticosteroids enhance the capacity of macrophages to induce th2 cytokine synthesis in cd4 lymphocytes by inhibiting il 12 production
Journal of Immunology, 1998Co-Authors: Rosemarie H Dekruyff, Yu Fang, Dale T UmetsuAbstract:We investigated the effects of Corticosteroids on IL-12 production by mouse splenic adherent cells and the subsequent capacity of these cells to induce cytokine production by CD4 + T cells. To distinguish the effects of Corticosteroids on APCs from those on T cells, only the APCs and not the T cells were exposed to Corticosteroids. Treatment of splenic adherent cells with dexamethasone greatly inhibited production of IL-12, a cytokine known to enhance IFN-γ synthesis and decrease IL-4 synthesis by CD4 + T cells. The reduction in IL-12 production by corticosteroid-treated macrophages decreased their ability to induce IFN-γ and increased their ability to induce IL-4 synthesis in Ag-primed CD4 + T cells. Splenic adherent cells from mice treated in vivo with dexamethasone also displayed a reduced capacity to produce IL-12. These results help to resolve previous conflicting observations regarding the effects of Corticosteroids on cytokine production by T cells, and indicate that while Corticosteroids may directly inhibit Th1 and Th2 cytokine production in T cells, Corticosteroids, by reducing IL-12 production in APCs, have the potential to indirectly enhance Th2 cytokine synthesis. Therefore, treatment of diseases such as allergy with chronic Corticosteroids may indirectly exacerbate the course of the disease, which is caused primarily by the overproduction of Th2 cytokines in allergen-specific CD4 + T cells.
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Corticosteroids inhibit il 12 production in human monocytes and enhance their capacity to induce il 4 synthesis in cd4 lymphocytes
Journal of Immunology, 1997Co-Authors: M H Blotta, Rosemarie H Dekruyff, Dale T UmetsuAbstract:We examined the effects of Corticosteroids on IL-12 production by human monocytes and on cytokine synthesis in T cells. To distinguish the effects of Corticosteroids on the APC used to activate the T cell from direct effects of Corticosteroids on the T cell, experiments were performed by exposing the APC and not the T cell to Corticosteroids. We found that Corticosteroids significantly inhibited the production in monocytes of IL-12, a cytokine that is extremely potent in enhancing IFN-gamma and inhibiting IL-4 synthesis in T cells. We demonstrated that reduced production of IL-12 in corticosteroid-treated monocytes resulted in a decreased capacity of the monocytes to induce IFN-gamma and an increased ability to induce IL-4 in T cells. These results suggest that although Corticosteroids may be beneficial for the treatment of asthma or allergic disease due to direct inhibitory effects of Corticosteroids on cytokine synthesis in T cells, chronic corticosteroid therapy may indirectly exacerbate the long-term course of allergic disease. This deleterious effect of Corticosteroids would result from a limitation in IL-12 production in tissue monocytes and macrophages, which would enhance production of Th2 cytokines (which augment allergic disease), and would reduce production of Th1 cytokines (which attenuate allergic disease) in T cells that subsequently infiltrate the tissues.
Fergus Daly - One of the best experts on this subject based on the ideXlab platform.
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antiviral agents added to Corticosteroids for early treatment of adults with acute idiopathic facial nerve paralysis bell palsy
JAMA, 2016Co-Authors: Frank Sullivan, Fergus Daly, Ildiko GagyorAbstract:Clinical Question Compared with oral Corticosteroids alone, are oral antiviral drugs associated with improved outcomes when combined with oral Corticosteroids in patients presenting within 72 hours of the onset of Bell palsy? Bottom Line Compared with oral Corticosteroids alone, the addition of acyclovir, valacyclovir, or famcyclovir to oral Corticosteroids for treatment of Bell palsy was associated with a higher proportion of people who recovered at 3- to 12-month follow-up. The quality of evidence is limited by heterogeneity, imprecision of the result estimates, and risk of bias.
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antiviral treatment for bell s palsy idiopathic facial paralysis
Cochrane Database of Systematic Reviews, 2015Co-Authors: Ildiko Gagyor, Fergus Daly, Vishnu Madhok, Dhruvashree Somasundara, Michael Sullivan, Fiona Gammie, Frank SullivanAbstract:BACKGROUND: 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. Significant morbidity can be associated with severe cases of Bell's palsy.OBJECTIVES: To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy.METHODS:Search methods:On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies.Selection criteria:We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without Corticosteroids versus control therapies for the treatment of Bell's palsy.We excluded trials that had a high risk of bias in several domains.Data collection and analysis:Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures.MAIN RESULTS: Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recovery:We found no significant benefit from adding antivirals to Corticosteroids in comparison with Corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.47 to 1.02, n = 1715). For people with severe Bell's palsy (House Brackmann scores of 5 and 6 or the equivalent in other scales), we found aMotor synkinesis or crocodile tears:In three trials comparing antivirals and Corticosteroids with Corticosteroids and placebo that assessed this outcome, we found a significant difference in long-term sequelae in favour or antivirals plus Corticosteroids (RR 0.73, 95% CI 0.54 to 0.99, n = 869). Three trials comparing antivirals alone with Corticosteroids alone investigating this outcome showed fewer sequelae with Corticosteroids (RR 1.44, 95% CI 1.11 to 1.85, n = 873). We found no data on long-term sequelae for other comparisons.Adverse events:Adverse event data were available in three studies giving comparison data on 1528 participants. None of the four comparisons (antivirals plus Corticosteroids versus Corticosteroids plus placebo or no treatment; antivirals versus Corticosteroids; antivirals plus Corticosteroids versus placebo; antivirals versus placebo) showed significant differences in adverse events between treatment and control arms. We could find no correlation with specific treatment within these results.AUTHORS' CONCLUSIONS: Moderate-quality evidence from randomised controlled trials showed no additional benefit from the combination of antivirals with Corticosteroids compared to Corticosteroids alone or with placebo, and no benefit from antivirals alone compared to placebo, for the treatment of Bell's palsy. Moderate-quality evidence showed a small but just significant benefit of combination therapy compared with Corticosteroids alone in severe Bell's palsy. We found no significant increase in adverse events from the use of antivirals compared with either placebo or Corticosteroids.
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withdrawn antiviral treatment for bell s palsy idiopathic facial paralysis
Cochrane Database of Systematic Reviews, 2015Co-Authors: Ildiko Gagyor, Fergus Daly, Vishnu Madhok, Dhruvashree Somasundara, Michael Sullivan, Fiona Gammie, Frank SullivanAbstract:Background 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. Significant morbidity can be associated with severe cases of Bell's palsy. Objectives To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy. Search methods On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies. Selection criteria We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without Corticosteroids versus control therapies for the treatment of Bell's palsy. We excluded trials that had a high risk of bias in several domains. Data collection and analysis Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures. Main results Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recoveryWe found no significant benefit from adding antivirals to Corticosteroids in comparison with Corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.47 to 1.02, n = 1715). For people with severe Bell's palsy (House-Brackmann scores of 5 and 6 or the equivalent in other scales), we found a reduction in the rate of incomplete recovery at month six when antivirals plus Corticosteroids were used (RR 0.64, 95% CI 0.41 to 0.99, n = 478). The outcome for the participants receiving Corticosteroids alone was significantly better than for those receiving antivirals alone (RR 2.09, 95% CI 1.36 to 3.20, n = 1169). The treatment effect of placebo was significantly lower than that of antivirals plus Corticosteroids (RR 0.56, 95% CI 0.41 to 0.76, n = 658). Antivirals alone had a non-significant detrimental effect on the outcome compared with placebo (RR 1.10, 95% CI 0.87 to 1.40, n = 658). Motor synkinesis or crocodile tearsIn three trials comparing antivirals and Corticosteroids with Corticosteroids and placebo that assessed this outcome, we found a significant difference in long-term sequelae in favour or antivirals plus Corticosteroids (RR 0.73, 95% CI 0.54 to 0.99, n = 869). Three trials comparing antivirals alone with Corticosteroids alone investigating this outcome showed fewer sequelae with Corticosteroids (RR 1.44, 95% CI 1.11 to 1.85, n = 873). We found no data on long-term sequelae for other comparisons. Adverse events Adverse event data were available in three studies giving comparison data on 1528 participants. None of the four comparisons (antivirals plus Corticosteroids versus Corticosteroids plus placebo or no treatment; antivirals versus Corticosteroids; antivirals plus Corticosteroids versus placebo; antivirals versus placebo) showed significant differences in adverse events between treatment and control arms. We could find no correlation with specific treatment within these results. Authors' conclusions Moderate-quality evidence from randomised controlled trials showed no additional benefit from the combination of antivirals with Corticosteroids compared to Corticosteroids alone or with placebo, and no benefit from antivirals alone compared to placebo, for the treatment of Bell's palsy. Moderate-quality evidence showed a small but just significant benefit of combination therapy compared with Corticosteroids alone in severe Bell's palsy. We found no significant increase in adverse events from the use of antivirals compared with either placebo or Corticosteroids.
Robert L Carithers - One of the best experts on this subject based on the ideXlab platform.
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Corticosteroids reduce risk of death within 28 days for patients with severe alcoholic hepatitis compared with pentoxifylline or placebo a meta analysis of individual data from controlled trials
Gastroenterology, 2018Co-Authors: A Louvet, Dong Joon Kim, M Thursz, Julien Labreuche, Stephen R Atkinson, Sandeep Singh Sidhu, John Ogrady, Evangelos Akriviadis, Emmanouil Sinakos, Robert L CarithersAbstract:Background & Aims We performed a meta-analysis of individual patient data from 11 randomized controlled trials comparing Corticosteroids, pentoxifylline, or their combination in patients with severe alcoholic hepatitis. We compared the effects of the treatments on survival for 28 days or 6 months, and response to treatment based on the Lille model. Methods We searched PubMed for randomized controlled trials of pharmacologic therapy for severe alcoholic hepatitis. Our final analysis comprised 11 studies, of 2111 patients. We performed 4 meta-analyses of the effects of Corticosteroids vs placebo or control, Corticosteroids vs pentoxifylline, Corticosteroids and pentoxifylline vs Corticosteroids and placebo or control, and pentoxifylline vs placebo. In each meta-analysis, the effect of treatment on the primary outcome (overall survival at 28 days, defined as the period from the first day of assigned treatment to 28 days) was estimated using a Cox proportional hazards regression model, including trials as random effect. Results Corticosteroid treatment significantly decreased risk of death within 28 days compared with controls (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.48–0.86) or to pentoxifylline (HR 0.64; 95% CI 0.43–0.95). In multiple-imputation and complete case analyses, the effect of Corticosteroids compared with controls remained significant. When we compared Corticosteroids vs pentoxifylline, the corticosteroid effect remained significant in the complete case analysis (HR 0.66; P = .04) but not in multiple-imputation analysis (HR 0.71; P = .08). There was no difference in 28-day mortality when patients were given a combination of Corticosteroids and pentoxifylline vs Corticosteroids alone or between patients given pentoxifylline vs control. In our analysis of secondary outcomes, we found no significant differences in 6-month mortality when any treatments or controls were compared. Corticosteroids were significantly associated with increased response to therapy compared with controls (relative risk 1.24; 95% CI 1.10–1.41) or pentoxifylline (relative risk 1.43; 95% CI 1.20–1.68). We found no difference in response to therapy between patients given a combination of Corticosteroids and pentoxifylline vs Corticosteroids alone or pentoxifylline vs controls. Conclusions In a meta-analysis of 4 controlled trials, we found corticosteroid use to reduce risk of death within 28 days of treatment, but not in the following 6 months. This loss of efficacy over time indicates a need for new therapeutic strategies to improve medium-term outcomes.
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Corticosteroids reduce risk of death within 28 days for patients with severe alcoholic hepatitis, compared with pentoxifylline or placebo-a meta-analysis of individual data
'Elsevier BV', 2018Co-Authors: Louvet A, Thursz Mr, Dj Kim, Labreuche J, Atkinson S, Ss Sidhu, Jg O'grady, Akriviadis E, Sinakos E, Robert L CarithersAbstract:BACKGROUND & AIMS: We performed a meta-analysis of individual patient data from 11 randomized controlled trials comparing Corticosteroids, pentoxifylline, or their combination in patients with severe alcoholic hepatitis. We compared the effects of the treatments on survival for 28 days or 6 months, and response to treatment based on the Lille model. METHODS: We searched PubMed for randomized controlled trials of pharmacologic therapy for severe alcoholic hepatitis. Our final analysis comprised 11 studies, of 2111 patients. We performed four meta-analyses of the effects of Corticosteroids vs. placebo or control, Corticosteroids vs. pentoxifylline, Corticosteroids and pentoxifylline vs. Corticosteroids and placebo or control, and pentoxifylline vs. placebo. In each meta-analysis, the effect of treatment on the primary outcome (overall survival at 28 days, defined as the period from the first day of assigned treatment to 28 days) was estimated using a Cox proportional hazards regression model, stratified by trial. RESULTS: Corticosteroid treatment significantly decreased risk of death within 28 days compared to controls (hazard ratio [HR], 0.64; 95% CI, 0.48-0.86) or to pentoxifylline (HR, 0.64; 95% CI, 0.43-0.95). In multiple imputation and complete case analyses, the effect of Corticosteroids compared to controls remained significant. When we compared Corticosteroids vs. pentoxifylline, the corticosteroid effect remained significant in the complete case analysis (HR, 0.66; P=.04) but not in multiple-imputation analysis (HR, 0.71; P=.08). There was no difference in 28-day mortality when patients were given a combination of Corticosteroids and pentoxifylline vs. Corticosteroids alone or between patients given pentoxifylline vs. control. In our analysis of secondary outcomes, we found no significant differences in 6-month mortality when any treatments or controls were compared. Corticosteroids were significantly associated with increased response to therapy compared with controls (relative risk, 1.24; 95% CI, 1.10-1.41) or pentoxifylline (relative risk, 1.43; 95% CI, 1.20-1.68). We found no difference in response to therapy between patients given a combination of Corticosteroids and pentoxifylline vs. Corticosteroids alone or pentoxifylline vs. controls. CONCLUSIONS: In a meta-analysis of 4 controlled trials, we found corticosteroid use to reduce risk of death within 28 days of treatment, but not in the following 6 months. This loss of efficacy over time indicates a need for new therapeutic strategies to improve medium-term outcomes
