Efficacy of immunosuppressive therapy in myocarditis: A 30-year systematic review and meta analysis

Cheng, Chun‐Yan; Cheng, Gang-Yi; Zhang, Shan; Baritussio, Anna; Lorenzoni, Giulia; Tymińska, Agata; Ozierański, Krzysztof; Iliceto, Sabino; Marcolongo, R; Gregori, Darío

doi:10.1016/j.autrev.2020.102710

Cited by 27 publications

(31 citation statements)

References 54 publications

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“…The survival of patients with myocarditis might be influenced by disease-specific treatment (there is available data about certain effective forms of immunosuppression for biopsy-proven myocarditis) [1,23,24]. Spontaneous or treatment-induced improvement of left ventricular function was observed within a few months of the disease onset in 40-50% to 90% of patients, respectively [3,25].…”

Section: Discussionmentioning

confidence: 99%

Occurrence, Trends, Management and Outcomes of Patients Hospitalized with Clinically Suspected Myocarditis—Ten-Year Perspectives from the MYO-PL Nationwide Database

Ozierański

Tymińska

Kruk³

et al. 2021

JCM

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The epidemiology of myocarditis is unknown and based mainly on small single-centre studies. The study aimed to evaluate the current incidence, clinical characteristics, management and outcomes of patients hospitalized due to myocarditis in a general population. The study was registered in ClinicalTrials.gov (NCT04827706). The nationwide MYO-PL (the occurrence, trends, management and outcomes of patients with myocarditis in Poland) database (years 2009–2020) was created to identify hospitalization records with a primary diagnosis of myocarditis according to the International Classification of Diseases and Related Health Problems, 10th Revision (ICD 10), derived from the database of the national healthcare insurer. We identified 19,978 patients who were hospitalized with suspected myocarditis for the first time, of whom 74% were male. The standardized incidence rate of myocarditis ranged from 1.15 to 14 per 100,000 people depending on the age group and was the highest in patients aged 16–20 years. The overall incidence increased with time. The performance of the recommended diagnostic tests (in particular, endomyocardial biopsy) was low. Relative five-year survival ranged from 0.99 to 0.56—worse in younger females and older males. During a five-year follow-up, 6% of patients (3.7% and 6.9% in females and males, respectively) were re-hospitalized for myocarditis. Surprisingly, females more frequently required hospitalization due to heart failure/cardiomyopathy (10.5%) and atrial fibrillation (5%) than compared to males (7.3% and 2.2%, respectively) in the five-year follow up. In the last ten years, the incidence of suspected myocarditis increased, particularly in males. Survival rates for patients with myocarditis were worse than in the general population. Management of myocarditis requires significant improvement.

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Section: Discussionmentioning

confidence: 99%

Occurrence, Trends, Management and Outcomes of Patients Hospitalized with Clinically Suspected Myocarditis—Ten-Year Perspectives from the MYO-PL Nationwide Database

Ozierański

Tymińska

Kruk³

et al. 2021

JCM

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“…1,3,[13][14][15][16] The relatively low frequency of positive viral genome in our series is promising in terms of the potential role of immunosuppression in the clinical management of myocarditis, since in expert position statements, including the most recent ESC heart failure guidelines, consideration of immunosuppression is recommended only for selected biopsy-proven virus-negative patients. 1,3,6,7,[13][14][15][16]…”

Section: Lack Of Prognostic Value Of Viral Pcr In Biopsy-proven Myoca...mentioning

confidence: 91%

Predictors of relapse, death or heart transplantation in myocarditis before the introduction of immunosuppression: negative prognostic impact of female gender, fulminant onset, lower ejection fraction and serum autoantibodies

Baritussio

Schiavo

Basso

et al. 2022

European J of Heart Fail

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“…This concept holds true especially in FM where early immunosuppression may be crucial to damper the inflammatory process sustaining AM. However, most studies focusing on immunomodulation have included patients with chronic inflammatory cardiomyopathy with HF symptoms for more than 6 months rather than those with a fulminant or complicated course ( 30 – 32 ). Though not supported by evidence from randomized clinical trials, recommendations for immunosuppression exist in the setting of complicated AM based on case series, expert opinions, and pathophysiological considerations ( 1 ) ( Figure 1 ).…”

Section: Lymphocytic Myocarditismentioning

confidence: 99%

Immunomodulating Therapies in Acute Myocarditis and Recurrent/Acute Pericarditis

et al. 2022

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The field of inflammatory disease of the heart or “cardio-immunology” is rapidly evolving due to the wider use of non-invasive diagnostic tools able to detect and monitor myocardial inflammation. In acute myocarditis, recent data on the use of immunomodulating therapies have been reported both in the setting of systemic autoimmune disorders and in the setting of isolated forms, especially in patients with specific histology (e.g., eosinophilic myocarditis) or with an arrhythmicburden. A role for immunosuppressive therapies has been also shown in severe cases of coronavirus disease 2019 (COVID-19), a condition that can be associated with cardiac injury and acute myocarditis. Furthermore, ongoing clinical trials are assessing the role of high dosage methylprednisolone in the context of acute myocarditis complicated by heart failure or fulminant presentation or the role of anakinra to treat patients with acute myocarditis excluding patients with hemodynamically unstable conditions. In addition, the explosion of immune-mediated therapies in oncology has introduced new pathophysiological entities, such as immune-checkpoint inhibitor-associated myocarditis and new basic research models to understand the interaction between the cardiac and immune systems. Here we provide a broad overview of evolving areas in cardio-immunology. We summarize the use of new imaging tools in combination with endomyocardial biopsy and laboratory parameters such as high sensitivity troponin to monitor the response to immunomodulating therapies based on recent evidence and clinical experience. Concerning pericarditis, the normal composition of pericardial fluid has been recently elucidated, allowing to assess the actual presence of inflammation; indeed, normal pericardial fluid is rich in nucleated cells, protein, albumin, LDH, at levels consistent with inflammatory exudates in other biological fluids. Importantly, recent findings showed how innate immunity plays a pivotal role in the pathogenesis of recurrent pericarditis with raised C-reactive protein, with inflammasome and IL-1 overproduction as drivers for systemic inflammatory response. In the era of tailored medicine, anti-IL-1 agents such as anakinra and rilonacept have been demonstrated highly effective in patients with recurrent pericarditis associated with an inflammatory phenotype.

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Efficacy of immunosuppressive therapy in myocarditis: A 30-year systematic review and meta analysis

Cited by 27 publications

References 54 publications

Occurrence, Trends, Management and Outcomes of Patients Hospitalized with Clinically Suspected Myocarditis—Ten-Year Perspectives from the MYO-PL Nationwide Database

Occurrence, Trends, Management and Outcomes of Patients Hospitalized with Clinically Suspected Myocarditis—Ten-Year Perspectives from the MYO-PL Nationwide Database

Predictors of relapse, death or heart transplantation in myocarditis before the introduction of immunosuppression: negative prognostic impact of female gender, fulminant onset, lower ejection fraction and serum autoantibodies

Immunomodulating Therapies in Acute Myocarditis and Recurrent/Acute Pericarditis

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