High-dose corticosteroids improve the prognosis of Bell's palsy compared with low-dose corticosteroids: A propensity score analysis

Objective: The aim of this study was to evaluate the effectiveness of high-dose corticosteroid (120 mg prednisolone equivalent daily) in Bell's palsy compared with low-dose corticosteroid (60 mg PSL equivalent). Methods: A single-center retrospective observational study was performed. We included adult Bell's palsy patients who were treated within 7 days after disease onset. We compared high- and low-dose corticosteroid for the non-recovery rate at 6 months after disease onset using inverse probability-weighted propensity score analysis (IPW-PS). Results: A total of 368 Bell's palsy patients (281 in the high-dose and 87 in the low-dose group) were included. The non-recovery rate without IPW-PS was 13.8% in the low-dose and 8.2% in the high-dose group. After IPW-PS adjustment, the non-recovery rate was 13.1% in the low-dose and 7.8% in the high-dose group (difference = -5.28%, 95% confidence interval [CI] -12.7% to -2.1%, p = 0.040). High-dose corticosteroid decreased the non-recovery rate in severe Bell's palsy patients with a Yanagihara score of 0-10 (difference = -16.1%, 95% CI -38.5% to -6.2%, p = 0.012), but did not decrease in moderate Bell's palsy patients with a Yanagihara score of 12-18 (difference = -2.0%, 95% CI -11.0% to 7.0%, p = 0.591). Subgroup analysis revealed that the efficacy of high-dose corticosteroids was higher when patients were treated within 3 days after disease onset, but not when patients were treated at 4 days or later after disease onset. Conclusions: Physicians would be better to treat severe Bell's palsy patients with high-dose corticosteroids when the patients are treated within 3 days after disease onset. (C) 2017 Elsevier B.V. All rights reserved.