Immunosuppressive therapy of myocarditis and inflammatory cardiomyopathy in the light of new data

This commentary refers to ‘Immunosuppressive therapy in virus-negative inflammatory cardiomyopathy: 20-year follow-up of the TIMIC trial’, by C. Chimenti et al., https://doi.org/10.1093/eurheartj/ehac348 and the discussion piece ‘Individualized immunosuppression in virus-negative inflammatory cardiomyopathy’, by A. Frustaci et al., https://doi.org/10.1093/eurheartj/ehac559. We wish to comment on the study recently published in the European Heart Journal1 entitled: ‘Immunosuppressive therapy in virus-negative inflammatory cardiomyopathy: 20-year follow-up of the TIMIC (Tailored Immosuppression in Inflammatory Cardiomyopathy) trial’. The paper presents important long-term results of the randomized, placebo-controlled TIMIC trial initially published by Frustaci et al.2 in 2009. The previous study played a leading role in the current position of endomyocardial biopsy and immunosuppressive therapy in virus-negative myocarditis/inflammatory cardiomyopathy. However, it is important to note that the current ESC guidelines still do not unequivocally recommend this treatment.3 Further, there are still major gaps in our knowledge of immunosuppression that should be answered in future prospective randomized trials to generate data relevant for international recommendations. Here, we list a few emerging issues that should be answered: