July 18, 2019Scientific ReportsOpen Access

Role of intravenous immunoglobulin therapy in the survival rate of pediatric patients with acute myocarditis: A systematic review and meta-analysis

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Why the study?

The treatment of pediatric myocarditis is controversial, and the benefits of intravenous immunoglobulin remain inconclusive due to limited data.

Does intravenous immunoglobulin (IVIG) therapy improve survival rate in pediatric patients with acute myocarditis?

Structured PICO

Does intravenous immunoglobulin (IVIG) therapy improve survival rate in pediatric patients with acute myocarditis?

Population

13 studies pooling 1,404 pediatric patients (<18 years of age) with acute myocarditis (812 received IVIG, 592 did not).

Intervention

Intravenous immunoglobulin (IVIG) therapy (various regimens, commonly 2 g/kg total dose)

Comparator

No IVIG treatment (standard care/supportive therapy)

Outcome

Survival rate (endpoint differed in each study from the time of discharge to 15 years)hard clinical

IVIG treatment is not associated with better survival in pediatric acute myocarditis after adjusting for publication bias, and cannot be routinely recommended based on current evidence.

Limitations

Only one RCT was available for analysis
High inter-study variability (diagnostic criteria, etiologies, IVIG regimens, and combination treatments)
Publication bias detected
Majority of included studies were retrospective cohort studies with serious risk of bias

Implication

IVIG may improve survival in pediatric myocarditis; hypothesis-generating and requires randomized confirmation before practice change.

Abstract

The treatment of pediatric myocarditis is controversial, and the benefits of intravenous immunoglobulin (IVIG) are inconclusive due to limited data. We searched studies from PubMed, MEDLINE, Embase, and Cochrane Library databases since establishment until October 1st, 2018. Thirteen studies met the inclusion criteria. We included a total of 812 patients with IVIG treatment and 592 patients without IVIG treatment. The meta-analysis showed that the survival rate in the IVIG group was higher than that in the non-IVIG group (odds ratio = 2.133, 95% confidence interval (CI): 1.32–3.43, p = 0.002). There was moderate statistical heterogeneity among the included studies (I 2 = 35%, p = 0.102). However, after adjustment using Duval and Tweedie’s trim and fill method, the point estimate of the overall effect size was 1.40 (95% CI 0.83, 2.35), which became insignificant. Moreover, the meta-regression revealed that age (coefficient = −0.191, 95% CI (−0.398, 0.015), p = 0.069) and gender (coefficient = 0.347, 95% CI (−7.586, 8.279), p = 0.93) were not significantly related to the survival rate. This meta-analysis showed that IVIG treatment was not associated with better survival. The use of IVIG therapy in acute myocarditis in children cannot be routinely recommended based on current evidence. Further prospective and randomized controlled studies are needed to elucidate the effects of IVIG treatment.