Intravenous immunoglobulin and steroids were evaluated for the treatment of acute myocarditis in children, though specific quantitative efficacy results are not reported in these supplemental materials.
Meta-Analysis (n=2,850)
Does adjunctive IVIG, steroids, or both reduce mortality and improve outcomes in children with acute myocarditis?
Adding IVIG to standard heart failure therapy may improve survival and cardiac function in children with acute complicated myocarditis, whereas steroids showed no significant benefit.
BACKGROUND: Therapeutic benefits of intravenous immunoglobulin (IVIG) and steroids remain inconclusive in optimizing treatment strategies for acute myocarditis. METHODS: PubMed, EMBASE, Cochrane databases, and Web of Science were searched for studies evaluating the effectiveness of adjunctive IVIG, steroids, or both with standard heart failure treatment in pediatric acute myocarditis. A random-effects network meta-analysis was conducted using frequentist and Bayesian approaches. Effect sizes were calculated as risk ratio (RR) and mean difference (MD). P-scores provided a ranking of treatments. RESULTS: Thirteen studies comprising 2850 participants were involved. Compared with standard treatment, IVIG reduced in-hospital mortality (RR, 0.52; 95% CI, 0.35-0.76), long-term mortality (RR, 0.5; 95% CI, 0.27-0.98), overall mortality (RR, 0.52; 95% CI, 0.34-0.76), and better composite outcome (RR, 0.61; 95% CI, 0.43-0.88). IVIG was optimal for reducing in-hospital and overall mortality and improving the composite outcome (P-scores = 0.993, 0.999, 0.986). Steroids or their combination with IVIG showed no significant benefit. IVIG improved cardiac function by increasing left ventricular ejection fraction (MD, 6.00%; 95% CI, 0.94-11.06) and reducing left ventricular end-diastolic diameter (MD, -3.77; 95% CI, -7.02 to -0.52). CONCLUSIONS: Integrating IVIG into standard treatment may significantly enhance outcomes in children with complicated acute myocarditis. IMPACT: This systematic review and network meta-analysis addresses the gap between clinical trial efficacy and real-world effectiveness in pediatric clinical practice. This study suggests that adding IVIG to standard heart failure therapy may improve survival and cardiac function in children with acute complicated myocarditis. The routine use of steroids requires the cautious clinical application. High-quality randomized controlled trials are needed to inform guidelines and optimize therapy.
Thai et al. (Tue,) conducted a meta-analysis in Acute myocarditis (n=2,850). Intravenous immunoglobulin (IVIG) and/or steroids vs. Standard heart failure therapy was evaluated on Mortality (in-hospital, long-term, overall). Intravenous immunoglobulin and steroids were evaluated for the treatment of acute myocarditis in children, though specific quantitative efficacy results are not reported in these supplemental materials.