A Systematic Review Incorporating Meta-Analysis on the Effectiveness of Intravenous Immunoglobulin Versus Corticosteroids in the Treatment of Pediatric Myocarditis

Background: Concerns have been raised about the efficacy of intravenous immunoglobulin and corticosteroids in pediatric myocarditis; however, the relationship between the risk and efficacy of these two therapies in children with myocarditis varies. Methods: A systematic review on seventeen studies was conducted in July 2020, which included 1,960 subjects at the baseline, with 788 receiving intravenous immunoglobulin and 142 receiving corticosteroids. The mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CIs) was calculated to assess the prognostic role of both treatments using dichotomous and continuous methods with random or fixed-effect models. Results: The use of intravenous immunoglobulin was significantly associated with a lower mortality rate or heart transplantation in children with myocarditis (OR, 0.55; 95% CI, 0.40-0.77, p < 0.001) compared with the control group. However, corticosteroids were not significantly associated with the same parameters (OR, 0.72; 95% CI, 0.31-1.63, p = 0.43). The use of intravenous immunoglobulin was not significantly related to improving left ventricular ejection in children with myocarditis (OR, 2.30; 95% CI, -9.65-14.25, p = 0.71) and so were corticosteroids (MD, 5.17; 95% CI, -0.26-10.60, p = 0.06). Conclusion: The use of intravenous immunoglobulin might have an independent risk relationship with a lower mortality rate or heart transplantation and is recommended in children with myocarditis to prevent complications.